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.