Serum 25-hydroxyvitamin D and cancer-related fatigue: associations and effects on depression, anxiety, functional capacity and health-related quality of Life in breast cancer survivors during adjuvant endocrine therapy.

BACKGROUND: The adjuvant treatment with Aromatase Inhibitor (AI) is considered standard of care for postmenopausal breast cancer (BC) women with hormone receptor-positive (HR +), however, it often causes adverse effects such as cancer-related fatigue (CRF). The high prevalence of vitamin D deficiency in postmenopausal women who start adjuvant AI supports the hypothesis that hypovitaminosis D would be one of the biological explanations for toxicity of AI. This study aimed to identify the relationship between 25-hydroxyvitamin D [25(OH)D] and CRF, and to analyze their associations and effects on depression, anxiety, functional disability, muscle/joint aches and HRQL. METHODS: This prospective study included 89 postmenopausal women diagnosed with HR + early BC in adjuvant endocrine therapy with AI. Anthropometric and body composition assessments were performed, as well as dietary assessments by application of 24-h dietary recall, at three time points, totaling 24 months of follow-up. The women completed the Cervantes Scale (CS), Hospital Anxiety and Depression Scale (HADS) and Health Assessment Questionnaire (HAQ). The CRF was determined from the Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F). The serum 25(OH)D was determined by electrochemiluminescence, with cut-off point above 75 nmol/L adopted as sufficiency. Generalized Linear Model (GLzM) and Generalized Mixed Model (GMM) analysis were used. RESULTS: At baseline, 36% (n = 32) of the women presented CRF and 39.3% (n = 35) had 25(OH)D below 75 nmol/L. None of the women reached the Estimated Average Requirements (EAR) of vitamin D. The causality between 25(OH)D and CRF was not significant. Longitudinally, lower levels of 25(OH)D had a negative effect on anxiety (p = 0.020), Menopause and Health (p = 0.033) and Vasomotor scores (p = 0.007). Also, the CRF had a negative effect on anxiety (p = 0.028); depression (p = 0.027); functional disability (p = 0.022); HRQL (p = 0.007); Menopause and Health (p = 0.042), Psychological (p = 0.008) and Couple Relations (p = 0.008) domains; and on Health (p = 0.019) and Aging (p = 0.036) subdomains. Vasomotor subdomain (ß = -2.279, p = 0.045) and muscle/joint aches (ß = -0.779, p = 0.013) were significant with CRF only at baseline. CONCLUSIONS: This study found negative effect of body adiposity on CRF. Still, the clinical relevance of 25(OH)D and CRF is highlighted, especially that of CRF, considering the consistent impact on several adverse effects reported by BC survivors during adjuvant endocrine therapy.

Nutritional Status and Growth Deficit in Children and Adolescents with Cancer at Different Moments of Treatment.

BACKGROUND: Nutrition deficits are common in children and adolescents undergoing cancer treatment and can contribute to a worse prognosis. There are scarce studies regarding this context considering different moments of treatment. The aim of this study was to evaluate the association between moment of treatment and nutritional status in children and adolescents with cancer. METHODS: A retrospective study was performed from January 2013 to December 2015, including data from all clinical records of patients under 18 years old with cancer. Clinical, nutritional support and anthropometric data were collected at four moments of treatment from cancer diagnosis: diagnosis (t0), 3 mo, (t1), 6 mo, (t2) and 1 year (t3). In addition, nutritional indicators were evaluated. Generalized Estimating Equation models were performed to analyze changes on anthropometric indices throughout four moments of treatment. RESULTS: The sample comprised 73 patients and frequency of nutritional deficits ranged from 13.0% to 18.6%. All nutritional indicators decreased at t1, showed a modest recovery at t2 and a stronger recovery at t3 (p < 0.001). Growth was also impacted during treatment, mainly on patients under 2 years in the first three months of treatment. CONCLUSIONS: Moment of treatment was associated with growth deficit and decreased percentiles in development indicators.