Hypercalcaemia : breast cancer:: risk of dying increased with a poor performance status and metastases.

Clinical bottom line (level 1b)

  1. Most patients with breast cancer and a first episode of hypercalcaemia were dead with 7.5 years.
  2. The risk of dying was increased if
    • WHO performance status grade 3 or 4
    • visceral metastases
    • bony metastases
    • a late treatment stage
Kristensen et al: Journal of Internal Medicine 1998; 244: 189-198
Expires November 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Denmark

212 patients (aged , 100% female) with breast cancer and a first episode of hypercalcaemia (serum ionised calcium > 1.35 mmol/l)

Factors studied:
  • age, serum calcium level, extent of metastatic disease, receptor status, WHO performance, treatment stage, serum creatinine, anti-hypercalcaemic treatment, anti-neoplastic treatment
  • WHO performance status grade 3 or 4
  • visceral metastases
  • bony metastases
  • late treatment stage


    • Patients could receive chemotherapy, prednisolone, calcitonin or mithramycin. No patients received bisphosphonates.

    Cox regression analysis performed to adjust for confounding factors

    ?100% followed for up to 7.5 years
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death up to 7.5 years 180/212 84.91%
    (80.08% to 89.72%)

    prognostic factor for
    death     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    WHO performance status grade 3 or 4 7.5 years 180/212
    (85%)     		4.12
    (2.88 to 5.88)     		9
    (8 to 11)
    visceral metastases 7.5 years 180/212
    (85%)     		4.06
    (2.10 to 7.85)     		9
    (8 to 14)
    bony metastases 7.5 years 180/212
    (85%)     		2.42
    (1.24 to 4.73)     		12
    (9 to 39)
    late treatment stage 7.5 years 180/212
    (85%)     		1.67
    (1.23 to 2.27)     		18
    (13 to 41)

    Citation

    1. Kristensen B, Ejlertsen B, Mouriden HT, et al: Survival in breast cancer patients after the first episode of hypercalcaemia. Journal of Internal Medicine 1998; 244: 189-198
    Search Terms: ?
    Contributor: Chris Ball and Musab Hayatli, November 1999
    Reviewer:

    Clinical Question.
    Patient breast cancer with a first episode of hypercalcaemia
    Intervention or Exposure WHO performance status, metastatic disease, treatment stage
    Outcome death