Kane et al provide an excellent and important contribution to the body of work informing clinicians on the nature of cancer induced bone pain (1). The work is timely, given that current evidence suggests that patients with cancer enjoy a greater longevity(2). This may be at the expense of greater morbidity, including bone pain(3). Nonetheless, it is vitally important to consider hypercalcaemia in any cancer patient presenting with bone pain, a fortori in those with known bone metastases. Hypercalcaemia is easily missed and can be fatal; with mortality rates of over 23% observed(4). It is very common and has been reported in up to 30% of patients with cancer, at some point during the disease process(5). The National Institute for Health and Clinical Excellence (NICE) recently updated its evience-based guidance on hypercalceamia in December 2014(6). Bone pain is cited as a cardinal feature that should arouse suspicion of hypercalcaemia. The presence of this symptom mandates enquiry into other associated features including polydipsia, polyuria, fatigue, abdominal pain, constipation, muscle weakness and altered mentation. In accordance with the guidance, serum calcium and albumin should be assayed to confirm or exclude the diagnosis. The inclusion of albumin allows the determination of corrected calcium(6). As such, serum corrected calcium and albumin should be added to the list of routine investigations for cancer patients with bone pain.
(1)Kane CM, Hoskin P, Bennett MI.Cancer induced bone pain. BMJ. 2015 Jan 29;350:h315
(2)http://www.ons.gov.uk/ons/dcp171778_389219.pdf
(3)Hawkes N. Increasing number of cancer survivors is putting pressure on NHS, says charity. BMJ. 2015;350:g7841
(4)Lee CT, Yang CC, Lam KK, Kung CT, Tsai CJ, Chen HC. Hypercalcemia in the emergency department. Am J Med Sci. 2006; 331:119-23
(5)Andrew F. Stewart Hypercalcemia Associated with Cancer. N Engl J Med 2005; 352:373-379
(6)http://cks.nice.org.uk/hypercalcaemia#!topicsummary
Rapid Response:
Kane et al provide an excellent and important contribution to the body of work informing clinicians on the nature of cancer induced bone pain (1). The work is timely, given that current evidence suggests that patients with cancer enjoy a greater longevity(2). This may be at the expense of greater morbidity, including bone pain(3). Nonetheless, it is vitally important to consider hypercalcaemia in any cancer patient presenting with bone pain, a fortori in those with known bone metastases. Hypercalcaemia is easily missed and can be fatal; with mortality rates of over 23% observed(4). It is very common and has been reported in up to 30% of patients with cancer, at some point during the disease process(5). The National Institute for Health and Clinical Excellence (NICE) recently updated its evience-based guidance on hypercalceamia in December 2014(6). Bone pain is cited as a cardinal feature that should arouse suspicion of hypercalcaemia. The presence of this symptom mandates enquiry into other associated features including polydipsia, polyuria, fatigue, abdominal pain, constipation, muscle weakness and altered mentation. In accordance with the guidance, serum calcium and albumin should be assayed to confirm or exclude the diagnosis. The inclusion of albumin allows the determination of corrected calcium(6). As such, serum corrected calcium and albumin should be added to the list of routine investigations for cancer patients with bone pain.
(1)Kane CM, Hoskin P, Bennett MI.Cancer induced bone pain. BMJ. 2015 Jan 29;350:h315
(2)http://www.ons.gov.uk/ons/dcp171778_389219.pdf
(3)Hawkes N. Increasing number of cancer survivors is putting pressure on NHS, says charity. BMJ. 2015;350:g7841
(4)Lee CT, Yang CC, Lam KK, Kung CT, Tsai CJ, Chen HC. Hypercalcemia in the emergency department. Am J Med Sci. 2006; 331:119-23
(5)Andrew F. Stewart Hypercalcemia Associated with Cancer. N Engl J Med 2005; 352:373-379
(6)http://cks.nice.org.uk/hypercalcaemia#!topicsummary
Competing interests: No competing interests