e19550 Background: Low serum vitamin D in cancer patients has been associated with inferior cancer outcomes and bone loss. The impact of chemotherapy on vitamin D levels is not known. We examined serum vitamin D levels during chemotherapy to identify magnitude and predictors of change. Methods: A prospective study of chemotherapy naïve patients commencing chemotherapy in two different sun exposure areas. Vitamin D (25(OH)D) deficiency was defined as ≤25 nmol/L and insufficiency 26-50 nmol/L. Demographic data, nutrition, sun exposure, season and biochemical parameters were collected at baseline 6 weeks (6W) and 12 weeks (12W) since commencement of treatment. The effects were assessed using a multivariate multilevel linear regression model that also included age, gender and BMI. Results: 82 Caucasian and 3 indigenous patients were enrolled. Median age was 57 (21-85) years. Forty-nine (58%) were female; 54 (65%) were treated with curative intent. Tumours included 29 (34%) breast,12 (14%) colorectal, 9 (11%) lymphomas, 7 (8%) leukemias, 7 (8%) lung, 5 (6%) ovarian, 3 (4%) testis, 3 (4%) unknown primary and 10 (11%) others. Median weight was 75 kg (50-151) and median BMI was 26.9 kg/m2 (17.7- 44.5). Seventy-six (89%) and 55 (65%) patients were receiving chemotherapy treatment at 6W and 12W respectively. Mean (±SD) serum 25(OH)D at baseline was 49.2±22.3 nmol/L. Ten (12%) patients were vitamin D deficient at baseline and a further 33 (41%) had insufficient levels. Mean serum 25(OH)D status was higher in higher sun exposure locations (61.9±22.1 nmol/L vs 42.2±19.2 nmol/L, p<0.001), varied according to season (spring=46.9±20.3 nmol/L, summer=50.8±18.2 nmol/L, fall=76.4±25.2 nmol/L, winter=36.5±15.7 nmol/L, p<0.001) and changed with treatment period (baseline=49.2±22.3 nmol/L, 6W=40.9±19.0 nmol/L, 12W=45.9±19.7 nmol/L, p=0.002). There was no association between 25(OH)D status and age, gender, BMI or nutritional status. Conclusions: Chemotherapy is associated with a fall in serum 25(OH)D. Further research is needed to determine the underlying mechanism, the impact of low serum 25(OH)D on patient outcomes and the potential role for screening and vitamin D supplementation in this group.