Prevalence and Associated Factors of Hypercalcemia of Malignancy Among Advanced Cancer Patients Attending Palliative Care Unit of a Tertiary Care Hospital in Bangladesh

Abstract

Background: Hypercalcemia is a common complication of advanced malignancy and a palliative care emergency. Its incidence increases in the later stages of the disease and is linked to a poor prognosis. Understanding the prevalence, clinical characteristics, and factors associated with malignancy-related hypercalcemia is crucial for developing targeted interventions and enhancing overall palliative care for advanced cancer patients.

Aim: This study aims to provide baseline data on the prevalence, clinical presentation, and factors associated with hypercalcemia among advanced cancer patients receiving palliative care in Bangladesh.

Methods: This cross-sectional study was conducted among 155 advanced cancer patients admitted to the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from June to December 2023. Data were collected through patient histories, physical examinations, and laboratory analyses. Statistical tests, including Chi-square test, Fisher's exact test, and Mann Whitney U test (for skewed data), were used to examine associations between socio-demographic and disease-related variables and serum calcium levels. Binary logistic regression was applied to identify factors affecting hypercalcemia.

Result: Among the participants, 20% had hypercalcemia, with 51.6% experiencing mild, 25.8% severe, and 22.6% moderate hypercalcemia. Head-and-neck cancers (12.9%) and gastrointestinal malignancies (22.6%) were more common in hypercalcemic patients. Lethargy, polyuria, polydipsia, constipation and dehydration were more prevalent among hypercalcemic participants. However, lethargy, nausea, confusion, drowsiness, abdominal pain, and constipation, which are typically more common in hypercalcemic patients, were more frequent in the normocalcemic group. Binary logistic regression analysis revealed that age between 41 and 65 years, male sex, poor performance status, and a short disease duration (up to 6 months) were significant risk factors for developing hypercalcemia among cancer patients.

Conclusion: Malignant hypercalcemia affected nearly one-fourth of patients with advanced malignancy in our study setting. It is important for healthcare providers to be aware of the common symptoms of hypercalcemia and to regularly monitor calcium levels in advanced cancer patients.

Keywords: hypercalcemia; neoplasm; palliative care; prevalence.