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

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

Objectives: The primary objective of this study is to retrospectively validate the proposed protocol by evaluating the efficacy of current management.

Study Design: retrospective, single center, chart review

Methods: Adult patients hospitalized between July 1, 2012 and November 1, 2015 with a diagnosis of both hypercalcemia and an active malignancy were included. The primary outcome for efficacy is normalization of corrected calcium within 4 and 7 days of treatment.  The protocol was retrospectively applied and results of patients who received treatment “per protocol” were compared to patients whose treatment did not follow protocol.

Results: A total of 496 patients with a diagnosis of hypercalcemia were identified to be evaluated for inclusion. Preliminary results of 80 patients included demonstrate that 42 patients were managed per protocol, and 38 off protocol.  When managed per protocol, 58% of patients achieved normalization of corrected calcium by day 4 and 47.6% by day 7.  This is compared to 47% and 23.7% retrospectively in patients whose treatment did not follow protocol. Results are underestimated due to a lack of data for patients discharged.

Conclusions: Based on preliminary results of this study, utilization of an evidence based protocol can improve normalization rates of corrected calcium in hypercalcemia of malignancy patients. Further data collection and subgroup analysis, to be completed by the time of presentation, will determine the impact on length of hospital stay, utilization of rescue therapy, and cost savings. Ultimately, results of this evaluation will be used to implement the proposed protocol and lead to an order set in Epic. This will help streamline, and ensure safe and effective management of hypercalcemia of malignancy.