Melanoma Lifestyle Study Summary

In the period between May 2000 and January 2005 the Leeds Melanoma group carried out a study designed to identify lifestyle factors which might be harmful for melanoma patients after diagnosis: more specifically, factors which increase the risk of recurrence of the cancer. Patients were recruited from the Northern and Yorkshire, West Midlands, Oxford and Trent regions of the UK and the study had two main findings.

  • The first was that the patients who had had a recurrence of the melanoma were more likely to feel financially insecure [1]
  • The second was that patients who had a recurrence of their cancer were less likely to have taken vitamin D supplements [2].

The finding that vitamin D might play an important role in health for melanoma patients was important but as this was a small study, it therefore had to be validated. In other words, we had to repeat the study in order to make sure that the conclusions were real. The Lifestyle Study was designed to do this.

We have in the interim reported that low measured levels of vitamin D in the blood at diagnosis of melanoma were associated with more deaths from melanoma [2] but the Lifestyle Study also allows us to look at dietary sources of vitamin D, the possible modifying effects of drugs such as statins, and survival.

We are all different, not least because our inherited genes are different so the study was designed to allow us additionally to factor in these genetic differences.

The main aims of the Lifestyle study were therefore to examine:

  1. The contribution of differences in diet as well as sun exposure on blood levels of vitamin D
  2. If vitamin D as supplements or within the diet, or other aspects of diet are associated with melanoma recurrence
  3. Whether these associations are different in people with particular inherited genetic variation
  4. If serum levels of vitamin D correlate with relapse, what levels are important?
  5. Whether vitamin D levels are associated with reduced levels of harmful inflammation
  6. Whether incidental drug exposure, e.g. to statins or aspirin has an effect on recurrence of melanoma
  7. Other factors that may affect risk of relapse by assembling a tissue (genomic DNA and serum) resource, e.g. we can use the stored tumour tissue to look at changes in the melanoma which might tell us more about the effects of vitamin D and drugs such as statins on the cancer

Study Design

The Lifestyle study was a case control study: the intent being to compare findings in melanoma patients who had recently had a recurrence of their melanoma with patients who had not relapsed for at least 3 years since the resection of the primary. Our hypothesis is that we will see that people who had recurrent disease (cases) were less likely to be taking vitamin D supplements than the controls (people who had not had a recurrence).

The patients who decided to take part in the study were asked to provide a single blood sample and complete a questionnaire on diet and the drugs and food supplements they had taken.  They were also asked to allow the researchers to seek information from their medical records and the cancer registries about any further cancer diagnoses or cause of death over time.

323 “cases” (patients who took part in the research shortly after a recurrence of their melanoma) and 723 “controls” (patients who had taken part in the research at least 5 years after diagnosis) were recruited to the study.

Progress of the study

Vitamin D levels have been measured in the blood samples and the data collected by questionnaire are being examined. We are currently seeking information from the cancer registries in order that we might understand if having a higher intake of vitamin D orally was associated with fewer deaths from melanoma and to see if there was any difference in the number of other cancers in cases and controls.

We have been slow to finish this study because of funding difficulties and the urgent need to explore further issues which arose in the research programme, but we hope to make more rapid progress now.

Pooling data

The role of incidental drug exposures is becoming increasingly important because in other studies we have reported that factors associated with illnesses such as heart diseases eg smoking also increase the risk of death from melanoma [3].  Drugs such as aspirin and statins are taken to reduce the risk of heart disease and we are trying to determine if these drugs have a beneficial effect on risk of melanoma recurrence. Work such as this requires very large numbers of patients to take part in this type of research and we will pool these data with those generated in other studies by the group.

Use of tissue

The hope to use the stored tumour samples from consenting patients to develop a test to allow melanoma teams to improve their estimate of prognosis for melanoma patients.

References

  1. Beswick, S., et al., Environmental risk factors for relapse of melanoma. Eur J Cancer, 2008. 44(12): p. 1717-25.
  2. Newton-Bishop, J.A., et al., Serum 25-Hydroxyvitamin D-3 Levels Are Associated With Breslow Thickness at Presentation and Survival From Melanoma. Journal of Clinical Oncology, 2009. 27(32): p. 5439-5444.
  3. Pozniak, J., et al., Genetic and Environmental Determinants of Immune Response to Cutaneous Melanoma. Cancer Res, 2019.