Hypercalcemia in advanced head and neck squamous cell carcinoma: prevalence and potential impact on palliative care

Hypercalcemia is common in patients with advanced head and neck squamous cell carcinoma (HNSCC). In this study, hypercalcemia was detected in 46 (51%) of 90 eligible patients with HNSCC over 4 years. Compared with nonhypercalcemics, hypercalcemics were more likely to be referred to palliative care, while they were inpatients (P = 0.004). During the last 3 months of follow-up, hypercalcemic patients were more likely than nonhypercalcemics to be hospitalized for > or = 14 days (P = 0.01) and to visit the emergency room more than once (P = 0.04). The median survival from the first hypercalcemic episode was 74 days (95% CI, 0-234). With data calculated from the date of referral to palliative care, hypercalcemics had a shorter survival than did nonhypercalcemics (43 vs 128 days, respectively; P = 0.046). Early detection and management of hypercalcemia in patients with HNSCC may improve the chance of preventing distressing symptoms and reducing unnecessary frequent emergency room visits and lengthy hospitalization.