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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 3
| Issue : 2 | Page : 372 |
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Author reply to Shamsi et al. and Vora
Avinash Pandey
Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| Date of Submission | 05-Apr-2020 |
| Date of Decision | 10-Apr-2020 |
| Date of Acceptance | 12-Apr-2020 |
| Date of Web Publication | 19-Jun-2020 |
Correspondence Address:
Avinash Pandey
Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/CRST.CRST_126_20
How to cite this article:
Pandey A. Author reply to Shamsi et al. and Vora. Cancer Res Stat Treat 2020;3:372 |
Shamsi and Usman [1] have pointed out that our use of the term “prevalence” was fallacious in the title of our manuscript, “Prevalence of Vitamin D deficiency in treatment-naive individual consecutive cancer patients.”[2] Prevalence is defined as “The proportion of individuals in a population having a disease or characteristic.”[3] Prevalence is also a statistical concept referring to the number of cases of a disease or deficiency that are present in a particular population at a given time. Our institute is the only regional cancer institute in the Indian state of Bihar. We had previously published our hospital-based cancer registry data and our pediatric data, both as the first and the only publication to date from this part of India.[4],[5] In the absence of a population-based cancer registry, our above data are close to and could be considered the next best representative of the cancer patient profile from this state of India. Hence, our chosen sample of individual consecutive patients used for our Vitamin D study, derived from a similar population, is also a representative of the average cancer patient profile here. Due to this reason, we consider the term “prevalence” apt for our study. Our sample, however, may not be a reflection of patients from the major metropolitan Indian cities.
We concur that comorbidities, complete nutritional status of the patient, body mass index, and biomarkers such as 1,25(OH)D, parathyroid hormone, calcium, magnesium, and phosphate were not reported in our study. These limitations have already been addressed in the discussion section of our published manuscript.[2] Gastrointestinal malignancies, especially esophageal cancer in our study, had a higher prevalence of low Vitamin D level compared to other sites. We believe that this may be due to nutrition limitation arising out of progressive dysphagia. Our study also reiterated that women with breast and ovarian cancer had subclinical Vitamin D deficiency, similar to that seen in normal postmenopausal women in the community.[6] We, however, do not consider the difference in the availability of sunlight to be a major factor for one malignancy compared to others as the cause of selective Vitamin D deficiency in cancer patients.
As highlighted by Vora,[7] our study was an observational, noninterventional cross-sectional study to answer only the question of what the prevalence of Vitamin D deficiency in treatment-naive cancer patients was. We did not pursue the association or causation of cancer due to low Vitamin D levels by comparing with a parallel noncancer age-matched control cohort. We also did not pursue the outcome of patients who took Vitamin D supplementation compared to those who did not, as this was beyond the purview of our study. Whether pretreatment or concurrent Vitamin D supplementation with standard therapy can improve cancer-related outcomes or reduce toxicities needs further exploration.[8]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Shamsi U, Usman S. Causal association of Vitamin D deficiency with cancer: More research needed. Cancer Res Stat Treat 2020;3:369-90.  [Full text] |
| 2. | Pandey A, Singh A, Singh S. Prevalence of Vitamin D deficiency in treatment-naive individual consecutive cancer patients. Cancer Res Stat Treat 2020;3:25-31. [Full text] |
| 3. | |
| 4. | Pandey A, Raj S, Madhawi R, Devi S, Singh RK. Cancer trends in Eastern India: Retrospective hospital-based cancer registry data analysis. South Asian J Cancer 2019;8:215-7. [ PUBMED] [Full text] |
| 5. | Pandey A, Singh A, Kumar V, Prakash J, Runu R, Thakur V, et al. Pediatric cancers in Bihar: A retrospective tertiary cancer center study. South Asian J Cancer 2020;9:53-5. [ PUBMED] [Full text] |
| 6. | Harinarayan CV. Prevalence of vitamin D insufficiency in postmenopausal south Indian women. Osteoporos Int 2005;16:397-402. |
| 7. | Vora CS. Let us not associate everything with cancer. Cancer Res Stat Treat 2020;3:371. [Full text] |
| 8. | Batra U, Sharma M. Association of Vitamin D with cancer – Catch me if you can!. Cancer Res Stat Treat 2020;3:78-80. [Full text] |
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