The following is a summary of “Patient and Physician Decisional Factors Regarding Hypercalcemia of Malignancy Treatment: A Novel Mixed-Methods Study,” published in the March 2023 issue of Endocrinology & Metabolism by Bassatne, et al.

For a study, researchers sought to gather information on patient and physician values, preferences, and attitudes towards hypercalcemia of malignancy (HCM) treatment to help inform the development of clinical practice guidelines (CPGs). 

A mixed-methods approach was used, including a systematic review of 5 databases to identify relevant studies on patient and physician values, costs, feasibility, acceptability, and equity in HCM treatment. Data on the cost of different treatment options were also collected from various countries. The study also involved collecting data on outcome prioritization from the CPG Working Group and patients with HCM through a questionnaire that evaluated their attitudes and perceptions toward treatment and the feasibility and acceptability of different treatment options. 

The systematic review included 2 cross-sectional surveys of physicians, who agreed that treating HCM improves symptoms and quality of life but emphasized the importance of considering the harms and benefits when deciding on the duration of treatment. The review also included 2 studies on cost, which found that intravenous bisphosphonate was more cost-effective than a combination of intravenous bisphosphonate and calcitonin and that the administration of intravenous zoledronic acid at home was more cost-effective than other intravenous bisphosphonates. The cost of zoledronic acid, denosumab, and cinacalcet varied widely among countries and types (brand vs generic). The CPG Working Group and patients with HCM agreed that survival and resolution of HCM were the most important outcomes when deciding on treatment, but there was some variation in the ratings for other outcomes.

In summary, the mixed-methods approach used in the study provided valuable information to support evidence-based recommendations for the treatment of HCM. The study’s focus on shared decision-making and incorporation of patient values and preferences into CPG development is an encouraging step toward more patient-centered healthcare.

Reference: academic.oup.com/jcem/article/108/3/563/6916874