The prevalence of hypercalcemia and associated factors among adult breast cancer patients in Mulago Hospital.

Abstract

Background: Hypercalcemia is among the commonest metabolic disorders associated with neoplasms, occurring in up to 25.7% of USA breast cancers. It is associated with high morbidity, poor quality of life and a grave prognosis. Its prevalence and associated factors among Ugandan breast cancer patients are unknown. There is need to quantify its magnitude and obtain surrogate clinical and laboratory markers that may contribute to prompt detection. Objective: The objective of this study was to determine the prevalence, severity and the factors associated with hypercalcemia among adult breast cancer patients attending Mulago hospital. Methods: In this descriptive cross-sectional study, 172 adult patients with confirmed breast cancer who consented to join were consecutively recruited until the sample size was attained. Data, using a pre-tested structured questionnaire, were collected on socio-demographic, clinical characteristics, drug use and laboratory parameters. Data analysis was performed using SPSS software package. A p-value of ≤ 0.05 was considered statistically significant. Factors that were found to be associated with hypercalcemia at bivariate analysis were subjected to multivariate analysis to establish those that were independently associated with hypercalcemia. Results: The prevalence of hypercalcemia (calcium ≥2.51mmol/L) was 36 (20.9 %). The grading of severity of hypercalcemia were mild 23 (63.9%), moderate 5 (13.9%) and severe 8 (22.2%). At bivariate analysis, feeling tired (P<0.001), feeling drowsy (P<0.001), feeling bone pains (P<0.001), not receiving cancer chemotherapy and hormonal therapy (P=0.036, P=<0.001), a dry oral mucosa (P<0.001), not having had a mastectomy (P=0.046), paraplegia (P<0.001), epigastric tenderness (P<0.001), late stage of cancer (P=0.003), presence of metastases (P<0.001), an HIV positive result (P<0.001) and urinalysis showing blood (P<0.001) were significantly associated with hypercalcemia. At multivariable analysis, a dry oral mucosa (P<0.001), epigastric tenderness (P=0.014), paraplegia (P=0.017), and a finding of blood in urine (P=0.028) were found to be independently associated with hypercalcemia. Conclusion: There is a high prevalence of hypercalcemia among breast cancer patients admitted to Mulago hospital or attending its clinics. Most of the hypercalcemia was mild but with significant proportions having moderate or severe forms. Factors associated with hypercalcemia included dry oral mucosa, epigastric tenderness, paraplegia and hematuria. Recommendation: Calcium levels should be regularly obtained among breast cancer patients with priority given to those with a dry oral mucosa, epigastric tenderness, paraplegia or hematuria.