Hypercalcemia of Malignancy: Time to Pull the Brakes

Abstract

Hypercalcemia of malignancy (HOM) is usually seen in advanced stage and carries a poor prognosis. Survival outcomes are dismal and most of the patients are unable to receive subsequent definite anti-cancer therapy. There is lack of any retrospective or prospective data regarding hypercalcemia of malignancy in Indian population. We aim to describe survival outcomes in hypercalcemia associated with solid organ malignancies. Forty-five patients diagnosed with HOM associated with solid organ malignancies were included in the study. Patients were followed up till death. Clinical features and survival outcomes were noted. Squamous cell carcinoma of head and neck region and lung comprised most of the cases associated with HOM. Most of the patients presented with poor performance status. Median overall survival (OS) was 20 days (2–78 days). Median OS was 35 days (9–58 days) in those who received definite anti-cancer therapy. Four-week mortality rate was estimated as 59.5%, while this increased to 75.7% within 6 weeks from the diagnosis of hypercalcemia. Survival outcomes are poor after the diagnosis of hypercalcemia in cancer patients. Best supportive care including hospice care should be strongly considered at this point of time instead of definite systemic anti-cancer therapy.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Burt ME, Brennan MF (1980) Incidence of hypercalcemia and malignant neoplasm. Arch Surg 115:704–707

    CAS  Article  Google Scholar 

  2. 2.

    Vassilopoulou-Sellin R, Newman BM, Taylor SH, Guinee VF (1993) Incidence of hypercalcemia in patients with malignancy referred to a comprehensive cancer center. Cancer 71:1309–1312

    CAS  Article  Google Scholar 

  3. 3.

    Grill V, Martin TJ (2000) Hypercalcemia of malignancy. Rev Endocr Metab Disord 1:253–263

    CAS  Article  Google Scholar 

  4. 4.

    Jick S, Li L, Gastanaga VM, Liede A (2015) Prevalence of hypercalcemia of malignancy among cancer patients in the UK: analysis of the Clinical Practice Research Datalink Database. Cancer Epidemiol 39:901–907

    Article  Google Scholar 

  5. 5.

    Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 [Online]. 2009 [cited 2009 May 28];[79 screens]. Available from: https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/Archive/CTCAE_4.0_2009-05-29_QuickReference_8.5x11.pdf

  6. 6.

    Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179–c184

    PubMed  Google Scholar 

  7. 7.

    Ramos REO, Perez Mak M, Alves MFS, Piotto GHM, Takahashi TK, Gomes da Fonseca L et al (2017) Malignancy-related hypercalcemia in advanced solid tumors: survival outcomes. J Glob Oncol 3:728–733

    Article  Google Scholar 

  8. 8.

    Penel N, Berthon C, Everard F, Neu JC, Clisant S, N’guyen M et al (2005) Prognosis of hypercalcemia in aerodigestive tract cancers: study of 136 recent cases. Oral Oncol 41:884–889

    CAS  Article  Google Scholar 

  9. 9.

    Ralston SH, Gallacher SJ, Patel U, Campbell J, Boyle IT (1990) Cancer-associated hypercalcemia: morbidity and mortality. Clinical experience in 126 treated patients. Ann Intern Med 112:499–504

    CAS  Article  Google Scholar 

  10. 10.

    Cripe JC, Buchanan TR Jr, Wan L, Hagemann R, McCourt CK, Massad LS et al (2019) Inpatient management of hypercalcemia portends a poor prognosis among gynecologic oncology patients: a trigger to initiate hospice care? Gynecol Oncol Rep 28:1–5

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

All authors contributed to final manuscript. DS, LA and MW were involved in the study design and protocol. DS, RS and LA contributed to data collection and manuscript writing. Data analysis and proof reading was done by DS and PPN.

Corresponding author

Correspondence to Deepak Sundriyal.

Ethics declarations

Conflict of Interests

The authors declare that they have no conflict of interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sundriyal, D., Arya, L., Saha, R. et al. Hypercalcemia of Malignancy: Time to Pull the Brakes. Indian J Surg Oncol (2020). https://doi.org/10.1007/s13193-020-01131-5

Download citation

Keywords

  • Hypercalcemia of malignancy
  • Bisphosphonate therapy
  • Squamous cell carcinoma
  • Best supportive care