Management and Outcomes in Head and Neck Cancer Patients with Malignancy Related Hypercalcaemia, an Oncological Emergency: A Cohort Study from a Tertiary Care Hospital in Tamil Nadu

Introduction: Malignancy-Related Hypercalcaemia (MRH) is a paraneoplastic syndrome often associated with various malignancies but has limited evidence available Head and Neck Cancers (HNC). Head and neck squamous cell carcinomas with MRH is rare but it has a unique propensity to induce hypercalcaemia, even in the absence of bone metastases. Despite its clinical significance, hypercalcaemia in this patient population is frequently missed, as its symptoms are often attributed to the underlying malignancy or its treatment. Aim: The present study aimed to analyse data on patterns of care, define the clinical profile of hypercalcaemia in HNC patients, evaluate treatment strategies employed during hospitalisation, and assess survival outcomes. Materials and Methods: The present cohort study was done and analysis was conducted on HNC patients hospitalised at Department of Radiation Oncology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India between January 2014 to July 2024 with symptomatic hypercalcaemia (serum total calcium >10.5 mg/dL) based on inpatient medical records. Data were extracted for the clinical profile, patterns of management and survival follow-up was from electronic medical records and telephonic follow-ups. Based on the serum total calcium levels, hypercalcaemia was categorised as mild, moderate and severe for the ranges, 10.5-11.9 mg/dL, 12-13.9 mg/dL; and more than 14 mg/dL, respectively. Descriptive statistics were used for categorical and continuous variables. Survival was analysed using Kaplan-Meier estimates using stata version 16.1 and python version 3.9.21. Results: Total of 19 patients was included in the study. The cohort was predominantly men 17 (89.47%), with median age of 51 years. 17 (89.47%) of patients had oral cavity cancers as the primary site of malignancy, with 9 (52.94%) originating from the tongue and 8 (47.05%) buccal mucosa. Most common presenting symptom was bone pain 13 (68.42%). Hypercalcaemia management included 14 (73.68%) of patients receiving a combination of hydration and bisphosphonates like zoledronic acid, 5 (26.31%) received hydration alone and 2 (10.52%) hydration and bisphosphonates patients were administered calcitonin also. Of the 19 patients, four were lost to follow-up, Overall mortality rate in the followed up patients (n=15) was 100%, with 8 (53.3%) of deaths occurring during the hospitalisation within seven days. Median survival was seven days and 11 (73.3%) of patients succumbed within 30 days of hypercalcaemia diagnosis. Conclusion: MRH remains a significant marker of poor prognosis. HNC patients who present with symptoms such as fatigue, lethargy, bone pain, or altered mental status should be evaluated for hypercalcaemia. Despite aggressive management, survival remains limited, emphasising the need for improved preventive and therapeutic strategies in future and necessity of early integration of palliative care team and psychological support in these patients.