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Inpatient folate testing at an academic cancer center: single-year experience

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Abstract

Purpose

The value of testing for folate deficiency has been scrutinized recently given low prevalence of deficiency with widespread dietary fortification. Numerous studies have shown folate testing to be low yield overall. However, the value of such testing in the inpatient cancer population has not been defined.

Methods

We queried all folate tests performed during 2017 at our center on admitted cancer patients. We used diagnosis codes and manual chart review to assess risk factors for folate deficiency. Descriptive statistics were used to summarize characteristics of patients undergoing folate testing, the frequency of vitamin B12 co-testing, and repeat folate testing. Fisher’s exact test was used to compare the proportion of deficient vs. not deficient tests based on the presence of risk factors. A Cox proportional hazards model was fit to examine the association between folate deficiency and survival.

Results

In total, 937 patients had 1065 tests performed during 2017. Among all tests, 7.0% indicated folate deficiency. In patients who underwent two folate tests in a single hospitalization, 89% were deficient neither instance. Risk factors for folate deficiency were equally common in instances with deficient compared with replete testing (25.3 vs. 20.4%, P = 0.334). Folate deficiency was associated with higher risk for death (HR 1.49, 95% CI 1.10–2.03, P = 0.01).

Conclusion

Folate deficiency was present in 7% of hospitalized cancer patients and associated with shorter overall survival. Repeat testing in the same patient over time was low yield. Traditional risk factors for folate deficiency do not appear to apply in this patient population.

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Funding

Dr. Korenstein’s work was supported in part by Cancer Center Support Grant P30 CA008748 to Memorial Sloan Kettering Cancer Center from the National Cancer Institute.

Author information

Author notes

  1. Brooke Barrow

    Present address: Warren Alpert Medical School, Brown University, Providence, RI, USA

Authors and Affiliations

  1. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Zachary D. Epstein-Peterson & Deborah Korenstein

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Diane G. Li, Jessica A. Lavery & Brooke Barrow

  3. Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Diane G. Li & Deborah Korenstein

  4. Department of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Ishita Chokshi

  5. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Deborah Korenstein

Authors
  1. Zachary D. Epstein-Peterson
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  2. Diane G. Li
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  3. Jessica A. Lavery
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  4. Brooke Barrow
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  5. Ishita Chokshi
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  6. Deborah Korenstein
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Corresponding author

Correspondence to Deborah Korenstein.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include name of committee + reference number) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The authors have collectively held full control over the primary data. They agree to journal review if so requested.

Conflict of interest

Spouse of author DK is on the scientific advisory board of Vedanta Pharmaceuticals and performs consulting work for Takeda Pharmaceuticals. There are no other conflicts to report.

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Epstein-Peterson, Z.D., Li, D.G., Lavery, J.A. et al. Inpatient folate testing at an academic cancer center: single-year experience. Support Care Cancer 28, 4235–4240 (2020). https://doi.org/10.1007/s00520-019-05267-1

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  • DOI: https://doi.org/10.1007/s00520-019-05267-1

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