Hostname: page-component-745bb68f8f-b6zl4 Total loading time: 0 Render date: 2025-01-13T06:09:11.955Z Has data issue: false hasContentIssue false
  • English
  • Français

Can depressed cancer patients with a borderline thiamine concentration develop deficiency within a short time period?

Published online by Cambridge University Press:  23 January 2023

Nozomu Uchida Open the ORCID record for Nozomu Uchida [Opens in a new window] ,
Mayumi Ishida Open the ORCID record for Mayumi Ishida [Opens in a new window] ,
Akira Yoshioka ,
Izumi Sato ,
Hiroshi Ito ,
Nobuyuki Onizawa ,
Ryota Sato ,
Naoki Mizunuma  and
Hideki Onishi Open the ORCID record for Hideki Onishi [Opens in a new window]
Nozomu Uchida
Affiliation:
Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
Mayumi Ishida
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Akira Yoshioka
Affiliation:
Department of Clinical Oncology, Mitsubishi Kyoto Hospital, Kyoto, Japan
Izumi Sato
Affiliation:
Department of Clinical Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
Hiroshi Ito
Affiliation:
Department of Internal Medicine, Ito Internal Medicine and Pediatric Clinic, Fukuoka, Japan
Nobuyuki Onizawa
Affiliation:
Department of General Medicine, Anzu Clinic, Saitama, Japan
Ryota Sato
Affiliation:
Department of Pharmacy, Maruki Memorial Medical and Social Welfare Center, Saitama, Japan
Naoki Mizunuma
Affiliation:
Tokyo Kagurazaka Law Firm, Tokyo, Japan
Hideki Onishi*
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
*
Author for correspondence: Hideki Onishi, Department of Psycho-oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Despite increasing reports of thiamine deficiency (TD) among cancer patients, there remain some patients with borderline thiamine concentrations (BTC). However, it is unclear whether such patients subsequently develop TD.

Methods

Here, we report cases of cancer patients progressing to TD within a short time period after presentation with BTC (24–28 ng/ml).

Results
Case 1

A 49-year-old female with lung cancer. During treatment for depression, the patient showed a decreased appetite, and a blood sample revealed BTC (25 ng/ml). Fourteen days later, she reported a continued loss of appetite, and despite the absence of the 3 classical signs of Wernicke encephalopathy (WE), additional testing showed a thiamine level of 23 ng/ml, leading to a diagnosis of TD.

Case 2

A 65-year-old female developed depression during chemotherapy for angiosarcoma. Her blood sample revealed BTC (25 ng/ml). Seven days later, despite the absence of the classical signs of WE, a further testing revealed a thiamine level of 20 ng/ml.

Case 3

A 41-year-old female developed depression during chemotherapy for ovarian cancer. No loss of appetite was observed, but a blood sample revealed BTC (25 ng/ml). Seven days later, despite the absence of the classical signs of WE or decreased appetite, further testing revealed a thiamine level of 19 ng/ml.

Significance of results

Depressed cancer patients with BTC may develop TD within a short time frame. To prevent TD, health-care professionals should maintain an awareness of its potential and the need for regular testing of thiamine level or prophylactic replacement therapy.

Keywords

Thiamine deficiencyWernicke encephalopathyBorderline levelDepressionCancer
Type
Case Report
Information
Palliative & Supportive Care , Volume 21 , Issue 4 , August 2023 , pp. 768 - 771
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aksoy, M, Basu, TK, Brient, J, et al. (1980) Thiamin status of patients treated with drug combinations containing 5-fluorouracil. European Journal of Cancer (1965) 16(8), 1041–1045. doi:10.1016/0014-2964(80)90251-0CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Washington, DC: American Psychiatric Publishing.Google Scholar
Barbato, M and Rodriguez, PJ (1994) Thiamine deficiency in patients admitted to a palliative care unit. Palliative Medicine 8(4), 320–324. doi:10.1177/026921639400800408CrossRefGoogle ScholarPubMed
Basu, TK, Aksoy, M and Dickerson, JW (1979) Effects of 5-fluorouracil on the thiamin status of adult female rats. Chemotherapy 25(2), 70–76. doi:10.1159/000237825CrossRefGoogle ScholarPubMed
Harper, CG, Giles, M and Finlay-Jones, R (1986) Clinical signs in the Wernicke-Korsakoff complex: A retrospective analysis of 131 cases diagnosed at necropsy. Journal of Neurology, Neurosurgery, and Psychiatry 49(4), 341–345. doi:10.1136/jnnp.49.4.341CrossRefGoogle ScholarPubMed
Ihara, H, Kakinoki, T, Morita, Y, et al. (2010) Whole blood concentration of total vitamin B1 in 602 patients with suspected vitamin B1 deficiency. Journal of Analytical Bio-Science 33(2), 179–183.Google Scholar
Isenberg-Grzeda, E, Kutner, HE and Nicolson, SE (2012) Wernicke-Korsakoff-syndrome: Under-recognized and under-treated. Psychosomatics 53(6), 507–516. doi:10.1016/j.psym.2012.04.008CrossRefGoogle ScholarPubMed
Isenberg-Grzeda, E, Shen, MJ, Alici, Y, et al. (2017) High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: Results of a single site prevalence study. Psycho-Oncology 26(9), 1384–1389. doi:10.1002/pon.4155CrossRefGoogle ScholarPubMed
Ito, H, Ishida, M, Itami, K, et al. (2021) Wernicke encephalopathy in a lung cancer patient receiving home medical care. Palliative & Supportive Care 19(4), 501–503. doi:10.1017/S1478951521000900CrossRefGoogle Scholar
McCormick, DB and Greene, HL (1994) Vitamins. In Burtis, CA and Ashwood, ER (eds), Textbook of Clinical Chemistry. Philadelphia: WB Saunders Company, 1290–1293.Google Scholar
Onishi, H, Ishida, M, Kagamu, H, et al. (2019) Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab. Palliative & Supportive Care 17(2), 245–247. doi:10.1017/S1478951518000469CrossRefGoogle Scholar
Onishi, H, Okabe, T, Uchida, N, et al. (2020a) Thiamine deficiency in a patient with recurrent renal cell carcinoma who developed weight loss with normal appetite and loss of energy soon after nivolumab treatment. Palliative & Supportive Care 18(2), 241–243. doi:10.1017/S1478951519000658CrossRefGoogle Scholar
Onishi, H, Sato, I, Uchida, N, et al. (2021) High proportion of thiamine deficiency in referred cancer patients with delirium: A retrospective descriptive study. European Journal of Clinical Nutrition 75(10), 1499–1505. doi:10.1038/s41430-021-00859-9CrossRefGoogle ScholarPubMed
Onishi, H, Uchida, N, Itami, K, et al. (2020b) Subclinical thiamine deficiency: What is the most appropriate method of diagnosis and treatment?. Palliative & Supportive Care 18(5), 614–616. doi:10.1017/S147895152000098XCrossRefGoogle ScholarPubMed
Oudman, E (2020) Wernicke encephalopathy in patients with depression: A systematic review. Psychiatry Clin Neurosci 74(10), 569–572.10.1111/pcn.13113CrossRefGoogle ScholarPubMed
Sechi, G, Sechi, E, Fois, C, et al. (2016) Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutrition Reviews 74(5), 281–300. doi:10.1093/nutrit/nuv107CrossRefGoogle ScholarPubMed
Sechi, G and Serra, A (2007) Wernicke’s encephalopathy: New clinical settings and recent advances in diagnosis and management. The Lancet Neurology 6(5), 442–455. doi:10.1016/S1474-4422(07)70104-7CrossRefGoogle ScholarPubMed
Sechi, GP, Bardanzellu, F, Pintus, MC, et al. (2021) Thiamine as a possible neuroprotective strategy in neonatal hypoxic-ischemic encephalopathy. Antioxidants (Basel) 11(1), . doi:10.3390/antiox11010042Google ScholarPubMed