Cancer-Associated Hypercalcemia: Morbidity and Mortality

Ralston, Stuart H.; Gallacher, Stephen J.; Patel, Uday; Campbell, James T.; Boyle, Iain T.

doi:10.7326/0003-4819-112-7-499

Cited by 316 publications

(158 citation statements)

References 15 publications

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“…Five patients had previously recived bisphosphonates for treatment of bone pain before developing TIH. The median serum calcium at time of first detection of (Ralston et al, 1990) and in a dose-finding study of APD (Ralston et al, 1988 This study is consistent with the above series and confirms the dismal prognosis of TIH. The overall survival of all patients treated with APD was less than 2 months.…”

Section: Redbtsupporting

confidence: 79%

Analysis of survival following treatment of tumour-induced hypercalcaemia with intravenous pamidronate (APD)

Ling

A’Hern²,

Hardy³

1995

Br J Cancer

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The outcome of 114 patients with tumour-induced hypercalcaemia (TIH) treated between January 1992 and June 1993 with intravenous pamidronate (APD) was retrospectively analysed. The median overall survival was 55 days (range 3 days to > 21 months): 86 days if systemic anti-cancer therapy was available and only 35 days if not (P < 0.001). Survival was also significantly better for those who became normocalcaemic post APD (53 days vs 19 days, P < 0.001). There was no survival difference with respect to patient sex, age, tumour type, treatment of bone metastases with radiotherapy, initial calcium level, initial dose of APD or time from tumour diagnosis to first TIH. In those patients in whom systemic anti-cancer therapy is available, treatment with APD improves survival, but in all other patients the primary aim of treatment should be symptom control. This study confirms the dismal prognosis of TIH.

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Section: Redbtsupporting

confidence: 79%

Analysis of survival following treatment of tumour-induced hypercalcaemia with intravenous pamidronate (APD)

Ling

A’Hern²,

Hardy³

1995

Br J Cancer

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“…The survival analyses presented here were not comprehensive in accounting for relevant clinical variables associated with survival, and therefore should be interpreted as exploratory in nature. In particular, we found longer survival rates compared to prior reports 27, 28, 29.…”

Section: Discussioncontrasting

confidence: 57%

Prevalence of hypercalcemia among cancer patients in the United States

et al. 2016

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Hypercalcemia of malignancy (HCM) is a serious metabolic complication whose population‐based prevalence has not been quantified. Rates of HCM differ by tumor type, with highest rates reported in multiple myeloma and lowest among colorectal and prostate cancer patients. This analysis estimates HCM prevalence in the US. This retrospective study used the Oncology Services Comprehensive Electronic Records (OSCER) warehouse of electronic health records (EHR) including laboratory values from 569000 patients treated at 565 oncology outpatient sites. OSCER data were projected to the national level by linking EHR to claims data. Cancer patients included were ≥18 years, and had serum calcium (Ca) and albumin (for corrected serum Ca [CSC]) records. Period prevalence was estimated by HCM CTCAE grade, tumor type, and year (2009–2013). Estimates were adjusted to capture patients diagnosed with HCM outside oncology practices based on a subset of patients linkable to office and hospital data. The analysis included 68023 (2009) to 121482 (2013) cancer patients. In 2013, patients with HCM had a median of six Ca tests, 69.7% had chemotherapy, and 34% received bone modifying agents. HCM rates were highest for multiple myeloma patients (7.5% [2012]–10.2% [2010]), lowest for prostate cancer (1.4% [2012]–2.1% [2011]).The estimated adjusted annual prevalence of HCM from 2009 to 2013 was 95441, 96281, 89797, 70158, and 71744, respectively. HCM affected 2.0–2.8% of all cancer patients. EHR data from oncology clinics were critical for this study because these data contain results from laboratory studies (i.e., serum calcium values) that are routinely ordered in that setting. We estimated that the prevalence of HCM in the US in 2013 is 71744, affecting approximately 2% of cancer patients overall. This percentage differs by tumor type and appears to have decreased over the five‐year study period.

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“…The incidence of hypercalcemia is low at the initial presentation of cancer (1%-5%) but increases dramatically in patients with advanced disease and a poor prognosis (5). In fact, the median duration of survival for patients with malignancy-associated hypercalcemia is only 2-6 months from the onset of hypercalcemia (3,5).…”

Section: Introductionmentioning

confidence: 99%

Onco-Nephrology

Rosner

Dalkin

2012

Clinical Journal of the American Society of Nephrology

134

108

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SummaryHypercalcemia complicates the course of 10%-30% of all patients with malignancies and can be a sign of very poor prognosis and advanced malignancy. Prompt recognition of the nonspecific signs and symptoms of hypercalcemia and institution of therapy can be lifesaving, affording the opportunity to address the underlying etiology. The mechanisms of malignancy-associated hypercalcemia generally fall into three categories: humoral hypercalcemia due to secreted factors (such as parathyroid-related hormone), local osteolysis due to tumor invasion of bone, and absorptive hypercalcemia due to excess vitamin D produced by malignancies. The mainstays of therapy for hypercalcemia are aggressive intravenous volume expansion with saline, bisphosphonate therapy, and perhaps loop diuretics. Adjunctive therapy may include calcitonin and corticosteroids. In refractory cases, gallium nitrate and perhaps denosumab are alternatives. In patients presenting with severe AKI, hemodialysis with a low-calcium bath can be effective. In most cases, therapy normalizes calcium levels and allows for palliation or curative therapy of the malignancy.

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Cancer-Associated Hypercalcemia: Morbidity and Mortality

Cited by 316 publications

References 15 publications

Analysis of survival following treatment of tumour-induced hypercalcaemia with intravenous pamidronate (APD)

Analysis of survival following treatment of tumour-induced hypercalcaemia with intravenous pamidronate (APD)

Prevalence of hypercalcemia among cancer patients in the United States

Onco-Nephrology

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