Retrospective chart evaluation of hypercalcemia management in oncology patients at the University of Chicago Medical Center

Abstract

Introduction

Due to the lack of formal guideline recommendations, available primary literature was used to develop a proposed protocol for management of hypercalcemia of malignancy at the University of Chicago Medical Center.

Methods

A retrospective, single center, observational study was performed including adult patients hospitalized with a diagnosis of hypercalcemia and active malignancy. Patients were retrospectively identified as treated in a manner aligned with the proposed protocol (“per protocol”) or not treated according to the proposed protocol (“off protocol”), and the outcomes were compared. The primary outcome for efficacy was normalization of corrected calcium within four and seven days of treatment.

Results

Normalization of corrected calcium was observed in 66% of patients managed per protocol compared to 65% of patients managed off protocol (p = 1.00) at day four, and in 73% of per protocol patients compared to 65% of off protocol patients (p = 0.44) at day seven. Areas identified where prospective implementation of the proposed protocol can improve management include: decreasing utilization of bisphosphonates in mild hypercalcemia, optimizing bisphosphonate dosing in renal impairment, decreasing intravenous phosphate repletion, and ensuring proper fluid management and calcitonin dosing.

Conclusion

Although a statistical difference was not detected in terms of normalization of corrected calcium levels, areas for optimization in management were identified. Therefore, implementation of the proposed protocol is expected to promote evidence-based management of hypercalcemia of malignancy management at University of Chicago Medical Center.