A retrospective analysis of the prevalence and clinical outcomes of vitamin D deficiency in myeloma patients in tropical Australia.

PURPOSE: The aim of this descriptive study was to assess the prevalence of vitamin D deficiency in patients on active therapy for multiple myeloma in a tropical climate. We also tested for the association of vitamin D status on clinical outcomes. METHODS: This was a single centre, observational study performed in Townsville, Australia, which has a sunlight heavy, tropical climate. Patients on active therapy for multiple myeloma underwent testing of serum 25-hydroxyvitamin D (25(OH)D). Information on disease stage, skeletal morbidity and symptoms of peripheral neuropathy were collected from medical records and self-reported patient questionnaires. RESULTS: A total of 41 patients were included. With a median disease duration of 38 months, 27% were found to be vitamin D deficient. Patients with vitamin D deficiency had a higher likelihood of peripheral neuropathy compared with their non-vitamin D counterparts (73% vs. 33%, P = 0.03). Although those with vitamin D deficiency had more skeletal morbidity, this was not statistically significant (73% vs 50%, P = 0.19). Reduced 25(OH) D was associated with a poor performance status (P = 0.003). There was no association between vitamin D status and stage of myeloma. CONCLUSION: There is a relatively high prevalence of vitamin D deficiency in patients with myeloma in our study. This is despite a sunlight heavy, tropical climate. We report an association between vitamin D deficiency and peripheral neuropathy. Prospective interventional trials are required to further assess this.

Protocol Paper: A Randomized Trial of 2 Creams in the Skin Care of Patients Receiving Radiation Therapy for Breast Cancer in the Tropics.

BACKGROUND: Nurses working in a northern Australia Radiation Therapy Unit advise all patients undergoing radiation therapy to use a readily available nonprescription moisturizing cream to minimize the severity of radiation skin reactions. However, patients report that the cream is thick and difficult to use in the humid tropical climate, and nurses anecdotally suspect an increase in severe skin reactions during the summer months. OBJECTIVE: This article presents the protocol for a randomized controlled trial that addressed a lack of evidence pertaining to the use of topical creams to prevent acute radiation skin reactions in a tropical climate. METHODS: Two skin care creams were used in the trial. The trial's primary outcome measure was the incidence of moist desquamation during treatment and 1 month after treatment completion. The secondary outcome was the participants' acceptance of the allocated cream at similar time points. RESULTS: Recruitment to the trial has been completed. Findings of the research will be reported in a separate publication. CONCLUSIONS: This article presents the protocol for a randomized controlled trial that addresses a lack of evidence pertaining to the use of topical creams to prevent acute radiation skin reactions in a tropical climate. IMPLICATIONS FOR PRACTICE: This protocol can be adapted by other researchers conducting practice-based research.

Effectiveness and Acceptability of a Moisturizing Cream and a Barrier Cream During Radiation Therapy for Breast Cancer in the Tropics: A Randomized Controlled Trial.

BACKGROUND: Inconsistent evidence about product effectiveness to prevent moist desquamation during radiation treatment and minimal research about the acceptability to patients of recommended products prompted this study. OBJECTIVE: This randomized controlled trial compared the effectiveness of 2 creams at minimizing the incidence of moist desquamation in a tropical setting and explored which product was most acceptable to patients receiving radiation treatment. METHODS: Participants (n = 255) were stratified according to breast or chest wall radiation treatment and randomly allocated to use a moisturizing or barrier cream. Nurses assessed radiation skin reactions weekly with a standardized grading system, and patients were telephoned 1 month after completing treatment for a final skin assessment. Participants completed an Acceptability Survey at similar times. RESULTS: At treatment completion, 15% of participants had moist desquamation. An additional 26% self-reported this at follow-up. Risk factors for moist desquamation included increased breast cup size and body mass index. The barrier cream significantly reduced the incidence of moist desquamation during treatment in patients receiving radiation to the chest wall (χ = 3.93, P = .047). Participants preferred the barrier cream over the moisturizer (χ = 5.81, P = .02) during treatment. CONCLUSIONS: This study identified a relatively high incidence of moist desquamation in patients receiving radiation therapy for breast cancer. Future patients will have information about product effectiveness in minimizing moist desquamation when choosing skin care products. IMPLICATIONS FOR PRACTICE: Structured discharge planning and patient education need to include information about factors that contribute to the likelihood of developing moist desquamation.