Low serum vitamin D levels have been associated with risk for certain malignancies, but studies have not directly analysed levels between community oncology and primary care practices. The purpose of this study was to compare serum vitamin D levels in patients at a community oncology practice with non-cancer patients at a primary care practice.
Retrospective case–control study. 25-Hydroxyvitamin D levels were ordered for screening in both cancer and non-cancer patients. Levels were compared in univariate and multivariate analyses adjusted for age, body mass index and season of blood draw.
A community-based radiation oncology centre and a community-based primary care practice: both located in Northeastern Pennsylvania, USA.
170 newly diagnosed cancer patients referred for initial consultation at the community oncology centre from 21 November 2008 to 18 May 2010, and 170 non-cancer patients of the primary care practice who underwent screening for hypovitaminosis D for the first time from 1 January 2009 to 31 December 2009.
Primary and secondary outcome measures
The primary outcome measure was mean serum vitamin D level, and the secondary outcome measures were frequencies of patients with vitamin D levels <20 ng/ml and levels <30 ng/ml.
The oncology patients had a significantly lower mean serum vitamin D level (24.9 ng/ml) relative to a cohort of non-cancer primary care patients (30.6 ng/ml, p<0.001) from the same geographical region. The relationship retained significance after adjustment for age, body mass index and season of blood draw in multivariate analysis (p=0.001). Levels <20 and <30 ng/ml were more frequent in the oncology patients (OR (95% CI)=2.59 (1.44 to 4.67) and 2.04 (1.20 to 3.46), respectively) in multivariate analysis.
Cancer patients were found to have low vitamin D levels relative to a similar cohort of non-cancer primary care patients from the same geographical region.
Our study sought to analyse vitamin D levels in large outpatient oncology and primary care centres.
Multiple levels of evidence suggest an association between low vitamin D and cancer.
Our findings of low vitamin D among the oncology patients add practical relevance to this association since we analysed patients at community clinics.
Providers caring for cancer patients should be aware of an increased incidence of hypovitaminosis D at the community level.
Strengths and limitations
Limitations include a relatively small sample size, lack of data on comorbid conditions of the primary care group, lack of data on vitamin D measurement and lack of data on supplementation or treatment that may have affected vitamin D levels.
Strengths include a community-based sample in both primary care and oncology patients and control of age, body mass index, latitude, time and season of blood draw and geographical region of both patient groups.