Introduction
Vitamin D plays an important role in calcium homeostasis and bone
health.1, 2 Large ecological studies have suggested a
link between Vitamin D deficiency and low UVB irradiation with increased
cancer incidence and mortality.3, 4 These studies
highlight a broader role for Vitamin D in the human body than previously
believed, with effects on immune function, metabolism5,
6 and cancer pathophysiology.7, 8
Adequate calcium and Vitamin D levels are important for growing children
and essential for adult bone health. Adequate calcium and Vitamin D
intake, in conjunction with adequate physical activity, are recommended
for cancer survivors, as well as for the general population. Children
diagnosed with acute lymphoblastic leukemia are treated with systemic
corticosteroids and have increased rates of skeletal complications such
as osteoporosis and vertebral fractures during and after their
treatment.9, 10 Additionally, suboptimal Vitamin D
levels have been associated with lower survival rates after stem-cell
transplantation11 and in patients with Hodgkin
Lymphoma.8
Data on Vitamin D deficiency and insufficiency among children with
newly-diagnosed cancer are very limited. Clinical research and Quality
Improvement (QI) initiatives aimed at improving Vitamin D status in this
population are lacking. We have previously reported that Vitamin D
deficiency and insufficiency are common in children with newly-diagnosed
cancer. Hispanic patients, females and older children were at higher
risk for Vitamin D deficiency and insufficiency at our
institution.12
At the University of California San Diego and Rady Children’s Hospital
San Diego, we noted high variability in Vitamin D testing,
supplementation and follow-up testing post-supplementation for children
with newly-diagnosed cancer. We conducted a QI initiative from November
1, 2015 to June 30, 2016 with the global aim to improve overall bone
health among children with newly-diagnosed cancer by standardizing
Vitamin D testing and supplementation.