Background Hypercalcemia of malignancy (HCM) is a common and significant cause of morbidity and mortality. Treatment includes clinically assisted hydration and bisphosphonates. Denosumab has been used in some centres. Clinical management of hypercalcaemia varies across settings and many recommendations are based on expert opinion.
Aim Within a Regional Palliative Care Clinical Network in the North West of England, we aimed to:
Evaluate the management of HCM in community, hospice and hospital settings
Develop new standards and guidelines
Systematic literature review.
Six-month retrospective case note analysis of the management of HCM in community, hospice and hospital patients.
Multi-professional questionnaire survey of palliative care professionals.
Results A systematic literature identified 32 articles to inform development of the regional standards and guidelines. Data for 79 patients was recorded from hospital (n=53, 67%), hospice (n=25, 32%) and community (n=1, 1%) settings. Patients reported high symptomatic burden: fatigue (n=41, 52%), weakness (n=38, 48%), drowsiness (n=32, 41%) and constipation (n=26, 37%). Intravenous fluids were administered in 72 (91%) patients; 0.9% saline was most used (n=67, 85%) within 24 hours of diagnosis (n=64, 81%). Bisphosphonates were used in 55 (70%): zoledronic acid (n=28, 35%) and pamidronate (n=24, 30%) were most common. Two (3%) received denosumab and one (1%) calcitonin. Thirty-four (43%) had a previous episode of HCM, 20 (25%) had an episode in previous 4 weeks of which 12 (60%) achieved normocalcaemia following bisphosphonates.
Plans for monitoring serum calcium were not documented in 33 (43%) cases. Many healthcare professionals considered treatment inappropriate in dying patients (n=51/66, 77%) and 8 (12%) had used denosumab previously for HCM.
Conclusion This analysis provides quantitative data about management of HCM across a variety of settings and has informed development of standards and guidelines. Further study is needed to determine the role of denosumab in management of HCM.
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