終末期癌症例における高カルシウム血症の検討

Hypercalcemia develops in patients with advanced cancer and severely deteriorates their quality of life. This study aimed to evaluate the influence of hypercalcemia on the clinical course of patients with end-stage cancer. This retrospective study included data on ２５３ patients who had cancer and died in the palliative care unit at Kondo-Naika Hospital in ２００８ and ２００９. Of these patients, １６（６．３％） developed hypercalcemia during hospitalization before death. These １６ patients included５patients with lung cancer ;４ with esophageal cancer ;２ with pancreatic cancer ; and１patient each with liver cancer, breast cancer, gall bladder cancer, renal cancer, or gastric cancer. The incidence of esophageal cancer in the patients with hypercalcemia was significantly higher than that in the patients who did not have hypercalcemia（p＜０．０１）. Of the １６ patients with hypercalcemia,１０had bone metastasis, whereas the other６patients had hypercalcemia even without bone metastasis. The main symptom of hypercalcemia was drowsiness in７patients, delirium in６patients, and general fatigue in ３patients. Fifteen patients were treated using bisphosphonates. After the hypercalcemia was detected, the １６patients survived for only a short time, with a mean survival time of １６．９ days. In particular, the mean survival time of ７ patients who did not respond to treatment for hypercalcemia was only ６．０days, and１patient with a calcium level of １９．１ mg／dl died the day after zoledronic acid hydrate therapy was initiated. Thus, hypercalcemia in patients with end-stage cancer seems to indicate extremely critical conditions with the worst prognosis.