Assessing the Impact of Vitamin D Supplementation on the Absolute Cell Counts in Cancer Patients Receiving Chemotherapy in a Tertiary Care Hospital: A Prospective Case-Control Study

Abstract

Background: Several clinico-epidemiological studies have shown a correlation between lower serum 25-hydroxy Vitamin D [25 (OH) D] levels and an increased risk of colorectal, breast, ovarian, and prostate cancers. The aim of this study was to assess the Vitamin D levels of cancer patients with confirmatory clinical diagnosis of breast, colorectal, gastric and ovarian cancers even before the initiation of cancer therapy and to observe & analyse the absolute cell counts of white blood cells which include Absolute Neutrophil Count-ANC, Absolute Lymphocyte count-ALC, Absolute Eosinophil count-AEC and Absolute Monocyte count-AMC in both the study and control groups.

Methods: A prospective case- control study was conducted between September 2022 to August 2023 in the Department of Oncology, King George Hospital, a tertiary care hospital situated in Visakhapatnam. Serum 25-hydroxy Vitamin D [25 (OH) D] levels were tested for a total of 194 cancer patients belonging to breast, ovary, gastric and colorectal cancers. The Maglumi 4000 Plus analyser instrument was used for the 25-OH Vitamin D assay. The 25-OH Vitamin D assay is a competitive chemiluminescence immunoassay. Vitamin D insufficiency is defined as having a serum 25 (OH) D level between 20 to 30 ng/mL, while patients with a level below 20 ng/mL were classified as having Vitamin D deficiency. Patients who had a Vitamin D level lower than 10 ng/mL were categorized as having severe Vitamin D deficiency. The total sample size was calculated to be 194 using the Raosoft calculator. Of the 194 patients, 5 were not willing to participate in the study, 9 patients missed the Vitamin D dose and 7 patients did not complete chemotherapy cycles due to various reasons. Hence a total of 173 patients were included in the study and among them, 160 patients were finally included in the study as 13 were having sufficient levels of Vitamin D, out of which 80 patients were included in the study/treatment group who were supplemented with Vitamin D3 60000IU capsules and the rest were included in the control group who were not supplemented with Vitamin D3. The Absolute cell counts of WBCs like the Absolute neutrophil Count, Absolute lymphocyte count, Absolute eosinophil count and Absolute monocyte count were observed and studied in both the study and control groups.

Results: In a total of 173 patients belonging to breast cancer, colorectal cancer, gastric and ovarian cancers, 13(7.5%) patients had sufficient levels of Vitamin D, 19(11%) patients had insufficient levels, 71(41.04%) had deficient and 70 (40.06%) patients had severely deficient levels of Vitamin D. The mean (±standard deviation) Vitamin D level was 12.30(±5.44) among the 160 cancer patients included in the study. Vitamin D deficiency was more prevalent among breast (91.3%) and ovary cancers (90%) which is evident that a high prevalence of vitamin D insufficiency is observed in patients with newly diagnosed breast cancer and ovarian cancers. Females were more deficient (90%) when compared to males (84%). Forty-six 46% in Stage III were and 44% in Stage II had vitamin D deficiency. 49% of Stage II and 48% of Stage IV were found to be severely deficient. Throughout the patient’s visits to their respective cycles at different time points for receiving chemotherapy, it was observed that the study group compared to the control groups had an impact on the ANC,ALC,AEC and AMC among the breast, colorectal and gastric carcinomas.

Conclusion: Vitamin D deficiency was well established in cancer patients in our study. Vitamin D deficiency in cancer patients has an impact on the prognosis of cancer patients. Overall, a total of 141/160 patients (87%) had deficiency in Vitamin D levels. Vitamin D supplementation in the study group definitely had an impact on the ANC, ALC, AEC and AMC parameters majorly among the breast, colorectal and gastric cancers.