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Cancer-Associated Hypercalcemia: Morbidity and Mortality: Clinical Experience in 126 Treated Patients

Stuart H. Ralston, MB ChB, MD; Stephen J. Gallacher, MB ChB; Uday Patel, MB ChB; James Campbell, MB ChB; and Iain T. Boyle, BSC, MB ChB
[+] Article, Author, and Disclosure Information

Grant Support: By Rorer Health Care, Eastbourne, United Kingdom.

Requests for Reprints: Stuart H. Ralston, MB ChB, MD, Rheumatic Diseases Unit, Northern General Hospital, Edinburgh EH5 2DQ, United Kingdom.

Current Author Addresses: Dr. Ralston: Rheumatic Diseases Unit, Northern General Hospital, Edinburgh E-H5 2DQ, United Kingdom.

Drs. Boyle and Gallacher: University Department of Medicine, Glasgow Royal Infirmary, Glasgow G31 2ER, United Kingdom.

Dr. Campbell: Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow G31 2ER, United Kingdom.

Dr. Patel: Radiology Department, Middlesex Hospital, London, United Kingdom.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;112(7):499-504. doi:10.7326/0003-4819-112-7-499
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Study Objective: To review the effects of antihypercalcemic treatment on morbidity and mortality in cancer-associated hypercalcemia.

Design: Retrospective study of 126 consecutive patients with cancer-associated hypercalcemia.

Setting: Inpatient referrals from a teaching hospital in the United Kingdom.

Intervention: Medical antihypercalcemic therapy supplemented by specific anticancer therapy where possible.

Measurements and Main Results: Median survival was 30 days. Survival did not differ in patients treated with different antihypercalcemic regimens but was longer (median, 135 days; P < 0.001) in a subgroup of 26 patients for whom specific anticancer therapy was available. Polyuria and polydipsia improved after therapy in 83% of cases, central nervous system symptoms in 71%, constipation in 70%, nausea and vomiting in 56%, anorexia in 50%, and malaise and fatigue in 47% (all significant, P < 0.001, pre-treatment compared with post-treatment). Pain control improved in only 23% of cases (not significant). Only 7% of patients with post-treatment serum calcium values above 3.50 mmol/L improved clinically compared with 80% whose calcium values fell below 2.80 mmol/L ( P < 0.001). Corresponding figures for the proportion of patients discharged from the hospital were 0% and 68% (P < 0.001).

Conclusions: Life expectancy is poor in cancer-associated hypercalcemia even in patients who are actively treated. Antihypercalcemic therapy has an important palliative role, however, because symptoms are usually improved and, in many cases, patients may be made well enough to be discharged from the hospital during the terminal stages of their illness.





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