Treatment Outcomes of Hypercalcemia of Malignancy Among Advanced Cancer Patients Attending Palliative Care Unit of a Tertiary Care Hospital in Bangladesh: An Observational Study.

BACKGROUND AND AIM

Hypercalcemia is one of the most common complications of advanced malignancy. Treatment of hypercalcemia among advanced cancer patients often gives rise to complex ethical issues. This study aims to explore treatment outcomes of hypercalcemia among advanced cancer patients so that palliative care physicians can design cost-effective and efficient approaches to diagnosis and treatment for these patients.

METHODS

This observational study was conducted among 31 advanced (stages III and IV) cancer patients diagnosed with hypercalcemia of malignancy admitted to the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from June to December 2023. The patients were observed on the day of admission and followed up on 3rd and 7th day for assessment of their response to the received treatment. Chi-square test, Fisher's exact test, paired and unpaired -tests were done to assess the treatment response and changes in the clinical characteristics of the patients.

RESULT

After 3 days of rehydration therapy, the mean serum calcium level decreased significantly from 12.43 ± 1.96 to 10.82 ± 2.07 after treatment, with a significant -value of < 0.001. For the management of remaining hypercalcemic patients, intravenous bisphosphonates are used in conjunction with normal saline. There was a substantial decrease in the mean value of serum calcium level from 12.66 ± 1.91 to 10.27 ± 0.75 after treatment with normal saline and bisphosphonate on the 7th day. The majority of patients (64.5%) showed improvement following treatment. A smaller percentage (16.1%) remained hypercalcemic even after getting all treatments. Unfortunately, 19.4% died, possibly due to the progressive nature of the disease along with hypercalcemia.

CONCLUSION

Malignant hypercalcemia is a potentially fatal, undiagnosed, and undertreated complication of advanced malignancy. It is essential for palliative care physicians to identify hypercalcemia and develop comprehensive care plan to optimize the treatment outcomes.