• Akira Shimada, Ichiro Mori, Isseki Maeda, Hidekazu Watanabe, Nobutaka Kikuchi, Hansheng Ding, and Tatsuya Morita.
• Tohoku University Hospital Palliative Care Center, Seiryo-cho 1-1, Aoba, Sendai, Miyagi, 980-8575, Japan, stetsu@med.tohoku.ac.jp.
• Support Care Cancer. 2015 Jan 1; 23 (1): 177-83.

BackgroundThere is no consensus regarding whether cancer-induced hypercalcemia should be treated up until the patient's death. The primary aim of this study was to clarify physicians' attitude toward treating recurrent hypercalcemia in terminally ill cancer patients and associated factors.MethodsA nationwide, cross-sectional survey was performed involving 757 physicians of the Japanese Society for Palliative Medicine. Physicians' attitude toward treating hypercalcemia in terminally ill patients was assessed based on the response to the question: do you agree that you provide medical treatment for recurrent hypercalcemia up until a patient's death? As the potential determinants of physicians' attitudes, we examined their characteristics, beliefs about hypercalcemia, and beliefs about a good death.ResultsWe obtained a total of 380 (50.2%) analyzable responses. A total of 163 physicians (43%) agreed that hypercalcemia should be treated up until the patient's death, while the remaining 217 physicians (57%) disagreed. The independent determinants of the attitude included the following: physicians' specialty, belief that hypercalcemia treatment improves pain, belief that hypercalcemia treatment improves nausea, belief that hypercalcemia treatment improves quality of life, belief that hypercalcemia treatment prolongs life, belief that the effect of hypercalcemia treatment reduces gradually, belief that death with hypercalcemia is less distressing, and the perception that being mentally clear is important for a good death.ConclusionJapanese physicians had different attitudes toward treating hypercalcemia in terminally ill patients. Physicians' beliefs about the efficacy of medical treatment for hypercalcemia markedly influenced their attitudes. Clarifying evidence on the effect of hypercalcemia treatment on patients' symptoms and prognoses is strongly encouraged.

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