Palliative care is helped by Vitamin D - many studies

Reduces pain, use of opioids, and fatigue

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Palliative care is augmented by Vitamin D, provided enough is given - 2020 PhD Thesis

Helde Frankling, Maria    PDF

The World Health Organization’s (WHO’s) definition of palliative care stresses the importance of early identification and assessment of physical symptoms in the palliative patient, to prevent and relieve suffering. The overall goal is to improve quality of life, and it is thus important that side effects of medical treatment do not outweigh beneficial effects. Vitamin D has few and mild side effects, and vitamin D treatment has well defined uses in medicine. However, the role of vitamin D supplementation to patients with advanced or metastatic cancer has rarely been studied. The papers included in this thesis aim at understanding the possible effects and optimal use of vitamin D in symptom management in palliative cancer patients, and to study effects of antibiotics in end-of-life cancer patients.

In study I, we investigated the effect of antibiotic use in patients in the last week of life. Almost 50 % in the studied cohort were treated with antibiotics during the last week in life; 37% of all patients and 50% of patients with septic symptoms experienced symptom relief.

Based on a study showing association between lower vitamin D levels and higher doses of opioids in patients with advanced cancer, we performed a pilot study to investigate effects of vitamin D in pain management, Quality of Life (QoL) and infections in patients with advanced or metastatic cancer, study II. Participants (n=39, with 25-hydroxyvitamin D < 75 nmol/L) received vitamin D 4000 IU/day for twelve weeks and were matched to untreated controls. After one month, the mean change in opioid dose was significantly lower in the vitamin D supplemented group -46 μg/h (95% CI -24-78), and difference increased over time. Differences in antibiotic use and QoL were also significant, in favor of the supplementation group.

The encouraging results from study II were used to plan study III, a multicentre, randomized, double blind placebo-controlled trial investigating the effect of vitamin D supplementation (4000 IU/day) on pain, infections, fatigue and QoL for 12 weeks. Last patient out was in June 2020, and results (submitted but not yet accepted manuscript) indicate a significant effect on opioid use and fatigue, but not on infections and QoL.

In a post-hoc analysis of a previously studied cohort of immunodeficient patients, study IV, we compared the effectiveness of vitamin D supplementation administered as oil drops versus powdered tablets in raising the individual’s vitamin D level. There was no significant difference between groups (p = 0.77). In a subgroup of patients without immunoglobulin replacement, vitamin D supplementation with oil drops (n = 34) but not with tablets (n = 60) resulted in significantly less antibiotic use (p < 0.001 and p = 0.58

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Trial eventually got most >20ng, a 2015 trial (below) found much better results when >40 ng

Many cancers patients have very low levels of Vitamin D
Took 12 weeks of 4,000 IU daily to get most >20 ng
They gave only 4,000 IU of vitamin D daily
Would have had much faster and better success by quickly restoring vitamin D levels
Example: start with 50,000 IU daily for a week followed by 50,000 weekly

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Thesis later published in Journal - 2021

‘Palliative-D’—Vitamin D Supplementation to Palliative Cancer Patients: A Double Blind, Randomized Placebo-Controlled Multicenter Trial
Cancers (Basel). 2021 Aug; 13(15): 3707 doi: 10.3390/cancers13153707
Maria Helde Frankling,1,2 Caritha Klasson,1,2,3 Carina Sandberg,3 Marie Nordström,3 Anna Warnqvist,4 Jenny Bergqvist,5,6 Peter Bergman,7,8 and Linda Björkhem-Bergman1,2,3,*
Eduardo Bruera, Academic Editor

In this study, the effect of vitamin D supplementation on pain, infections, fatigue and quality of life in patients with advanced cancer with verified vitamin D deficiency was studied. To this end, a randomized controlled trial, ‘Palliative-D’, was conducted, comparing the effect of 4000 IU vitamin D3/day for 12 weeks to placebo in cancer patients admitted to palliative care. Pain was assessed as change in opioid dose and infections measured as days on antibiotics. Vitamin D-supplemented patients increased their opioid doses at a significantly slower rate than patients receiving placebo, i.e., 0.56 µg less fentanyl/h per week with vitamin D treatment. Vitamin D reduced self-assessed fatigue but did not affect antibiotic use or self-assessed Quality of life. The treatment was safe and well-tolerated. In conclusion, correction of vitamin D deficiency may have positive effects on pain and fatigue in palliative cancer patients.

Abstract
The aim of the ‘Palliative-D’ study was to test the hypothesis that correction of vitamin D deficiency reduces opioid use in cancer patients admitted to palliative care. A multicenter randomized, placebo-controlled, double-blind trial in three home-based palliative care facilities in Sweden was performed. Patients with advanced cancer and 25-hydroxyvitamin D < 50 nmol/L were randomized to vitamin D3 4000 IU/day or placebo for 12 weeks. The primary endpoint was the difference of long-acting opioid use (fentanyl ug/h) between the groups during 12 weeks, based on four time points. Secondary outcomes included changes in antibiotic use, fatigue and Quality of Life (QoL). A total of 244 patients were randomized, and 150 patients completed the 12 weeks. The major reason for drop-out was death due to cancer. The vitamin D-group had a significantly smaller increase of opioid doses compared to the placebo-group; beta coefficient −0.56 (p = 0.03), i.e., 0.56 µg less fentanyl/h per week with vitamin D treatment. Vitamin D-reduced fatigue assessed with ESAS was −1.1 points after 12 weeks (p < 0.01). Antibiotic use or QoL did not differ significantly between the groups. The treatment was safe and well-tolerated. In conclusion, correction of vitamin D deficiency may have positive effects on opioid use and fatigue in palliative cancer patients, but only in those with a survival time more than 12 weeks.
 Download the 2022 PDF from VitaminDWiki

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Post-Hock analysis of the ‘Palliative-D’ trial - Jan 2022

Nutrients 2022, 14(3), 602; https://doi.org/10.3390/nu14030602
25-Hydroxyvitamin D in Cancer Patients Admitted to Palliative Care: A Post-Hoc Analysis of the Swedish Trial ‘Palliative-D’
by Maria Helde Frankling, Caritha Klasson, Linda Björkhem-Bergman

• Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden
• Thoracic Oncology Center, Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
• Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-112 19 Stockholm, Sweden

The purpose of this study is to explore 25-hydroxyvitamin D (25-OHD) levels in patients with cancer in the palliative phase in relation to season, sex, age, tumor type, colectomy, and survival. To this end, we performed a post-hoc analysis of ‘Palliative-D’, a randomized placebo-controlled, double-blind trial investigating the effect of daily supplementation with 4000 IU of vitamin D for 12 weeks on pain in patients in palliative cancer care. In the screening cohort (n = 530), 10% of patients had 25-OHD levels < 25 nmol/L, 50% < 50, and 84% < 75 nmol/L. Baseline 25-OHD did not differ between seasons or tumor type and was not correlated with survival time. In vitamin D deficient patients supplemented with vitamin D (n = 67), 86% reached sufficient levels, i.e., >50 nmol/L, after 12 weeks. An increase in 25-OHD was larger in supplemented women than in men (53 vs. 37 nmol/L, p = 0.02) and was not affected by season. In the placebo-group (n = 83), decreased levels of 25-OHD levels were noted during the study period for patients recruited during the last quarter of the year. In conclusion, cancer patients in palliative phase have adequate increase in 25-OHD after vitamin D supplementation regardless of season, age, tumor type, or colectomy.
 Download the 2022 PDF from VitaminDWiki

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See also VitaminDWiki

• Hospice and palliative care – Vitamin D, CBD, and Medical Cannabis
• Opioid use in palliative cancer patients far less if high level of vitamin D – May 2015
  
• Palliative cancer benefit of 4,000 IU of Vitamin D – less opioids, infection, and CRP – Aug 2017 = thesis author
  • Decreased use of Opiates
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  • Decreased use of antibiotics
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  • Increased Vitamin D levels
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VitaminDWiki - Pain - chronic category contains

165 items in category Chronic pain

See also

• Overview Pain and Vitamin D
• Percentage of people with pain increased 25 percent in 18 years – Jan 2019
• Pain not reduced by 60,000 IU monthly vitamin D (need 50,000 IU weekly) – RCT Aug 2023
• Overview Fibromyalgia or Chronic Fatigue and vitamin D
• Overview Rheumatoid Arthritis and vitamin D
• Shingles and vitamin D
• Shin splints decrease with vitamin D
• Migraine and Vitamin D
• Headache category 82 items
• "musculoskeletal pain" 490 items as of Aug 2023
• "chronic fatigue" 185 items as of Jan 2017
• Category Back Pain 44 items
• 7 pain studies in VitaminDWiki with KNEE in the title as of Aug 2023 (see below)
• Opioid OR Opiate OR Morphine in the title 10 pages as of June 2021

VitaminDWiki - Loading Dose of Vitamin D category contains

206 items in category
see also Overview Loading of vitamin D   Overview Toxicity of vitamin D
Better than Daily 1: Fewer chances to forget, 2) Gets past receptor barrier
Injection category has 64 items
 
It appears that over 1 million Vitamin D loading doses have been taken
Doses ranged from 100,000 to 600,000 IU over a period of a day to a month
No reports of serious adverse reactions
Many studies report on the benefits resulting from loading doses

TOP articles in Loading Dose of Vitamin D

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Palliative and Hospice compared

• Hospice is comfort care without curative intent; the patient no longer has curative options or has chosen not to pursue treatment because the side effects outweigh the benefits.
• Palliative care is comfort care with or without curative intent.

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VitaminDWiki pages with PALLIATIVE of HOSPICE in title (7 as of Sept 2022)

This list is automatically updated

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