Background Metastatic Spinal Cord Compression (MSCC) is a progressive, painful and disabling condition experienced by between 2.5 and 5% of cancer patients (Loblaw, Laperriere & Mackillop, 2003. Clinical Oncology (R Coll Radiol). 15: 211). Compression of the spinal cord from metastases can cause pain, a reduced ability to walk and continence problems, all of which will progress without early recognition and treatment (Nakata, Sugihara, Sugawara, et al., 2020. Oncol Lett. 19: 3137).
It is well documented that this patient group continues to present late with devastating results (Levack, Graham, Collie, et al., 2002. Clin Oncol ( R Coll Radiol). 14: 472). MSCC is most prevalent in patients with widespread disseminated disease (Nakata, Sugihara, Sugawara, Nakahara, et al., 2020), and as a result the hospice and palliative care community teams encounter these patients on a regular basis. It was noted that there was no clear communication route or guidance for community staff who were concerned that a patient may be displaying signs of MSCC. There was also no single point of contact within acute oncology to address these concerns at an appropriate level of urgency and in a uniform way.
Aim To gain consensus on when investigations were deemed appropriate and on subsequent management.
Methods A working party was established to address these issues, with hospice staff working in partnership with oncology staff. The group collaborated with a number of specialists and stakeholders within both the acute and community trusts.
Results Using NICE guidance (Metastatic spinal cord compression in adults: risk assessment, diagnosis and management. Clinical guideline [CG75]), the working party agreed on and created a pathway and guidelines for the identification and management of all suspected MSCC patients in Gloucestershire.
Conclusions The pathway has been a great success within the palliative care community with physios, doctors and CNS teams using it regularly to identify suspected MSCC patients and make an action plan with the Acute Oncology Service. The pathway aids in establishing clarity when discussing patients with acute oncology teams and consultants, empowering referrers and decreasing delays in accessing investigations.
In the future, a more formal audit of the pathway’s impact would be useful, alongside exploring methods of disseminating the pathway to the wider clinical community.
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