Principles of management of hypercalcaemia associated with cancer

The aims of managing hypercalcaemia associated with cancer are to improve symptoms, reduce corrected serum calcium concentration to within the normal range and, if possible, address the cause. Consider the potential benefits and burdens of each intervention and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.

Always review the patient’s medications and consider stopping or reducing the dose of drugs that exacerbate hypercalcaemia (eg calcium supplements, vitamin D, thiazide diuretics).

The severity of symptoms and, therefore, urgency of treatment is determined by the degree of hypercalcaemia and the rate of the rise of the serum calcium concentrationZagzag, 2018. Urgent treatment is generally not required for asymptomatic hypercalcaemia or hypercalcaemia with a serum total calcium concentration corrected for albumin less than 3.0 mmol/L.

Initial treatment of symptomatic hypercalcaemia associated with cancer is with intravenous rehydration; addition of a bisphosphonate may be required. If intravenous bisphosphonates are contraindicated (eg severe kidney impairment) or hypercalcaemia is recurrent, seek expert advice.

Recurrent or refractory hypercalcaemia usually indicates that the patient is reaching the last days of lifeZagzag, 2018. Carefully discuss and plan end-of-life care with the patient, and their family and carers—see Preparing for the last days of life.