Tumour induced hypercalcaemia: a case for active treatment

This paper reports a retrospective survey of the diagnosis, management and outcome of hypercalcaemia in patients admitted to a regional oncology centre over a 12-month period; 168 cases of tumour induced hypercalcaemia were identified. In 69 patients (41%) the presence of hypercalcaemia was not noted in the case records; in a further 15 patients (9%) a positive decision was made not to treat the condition, although some of these patients continued to receive other forms of active treatment. Of the remaining patients, 20 (12%) received intravenous fluids alone and 64 (38%) received bisphosphonate therapy. Of those patients with initial serum calcium > 3 mmol/l 71% were treated with bisphosphonates. Median survival from onset of hypercalcaemia was only 2 months, but in the bisphosphonate treated group, 98% experienced a fall in serum calcium within a week of treatment. We believe that the symptomatic relief associated with a fall in serum calcium justifies active management even in the face of a poor prognosis. A large proportion of cases of tumour induced hypercalcaemia remain undiagnosed or untreated and we believe that this deserves further attention.