Excerpt

It is difficult to know what the true incidence of metastatic spinal cord compression (MSCC) is in England and Wales because the cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Ontario, Canada, suggests that the incidence may be up to 80 cases per million population per year. This would mean around 4000 cases per year in England and Wales or more than 100 cases per cancer network per year.

The Clinical Resource and Audit Group (CRAG) audit clearly showed that there were significant delays from the time when patients first developed symptoms until hospital doctors and general practitioners recognised the possibility of spinal cord compression and made the appropriate referral. The median times from the onset of back pain and nerve root pain to referral were 3 months and 9 weeks respectively. As a result, 48% of patients were unable to walk at the time of diagnosis and of these the majority (67%) had recovered no function at 1 month. Of those walking unaided at the time of diagnosis (34%), 81% were able to walk (either alone or with aid) at 1 month. The ability to walk at diagnosis was also significantly related to overall survival.

At present, relatively few patients with malignant spinal cord compression in the UK receive surgery for the condition. But research evidence suggests that early surgery may be more effective than radiotherapy in a selected subset of patients.

Contents

• Foreword
• Key priorities
• Key research recommendations
• Recommendations
• Methodology
• Algorithms
• 1. Epidemiology
  • 1.1. Introduction
  • 1.2. Incidence
  • 1.3. Aetiology and pathophysiology
  • 1.4. Clinical symptoms and signs
  • 1.5. Survival/mortality
  • 1.6. Service provision
  • 1.7. Conclusions
  • References
• 2. Service configuration and urgency of treatment
  • 2.1. Introduction
  • 2.2. MSCC coordinator and senior clinical adviser – roles and responsibilities
  • References
• 3. The patient’s experience of MSCC
  • 3.1. Introduction
  • 3.2. Emotional and family support
  • References
• 4. Early detection
  • 4.1. Introduction
  • 4.2. Communicating symptoms and risks
  • 4.3. Early symptoms and signs
  • References
• 5. Imaging
  • 5.1. Introduction
  • 5.2. Choice of imaging modality
  • 5.3. Routine MRI and early detection of MSCC
  • 5.4. Timing of MRI assessment
  • 5.5. Health economic evaluation for timing of MRI in MSCC
  • References
• 6. Treatment of spinal metastases and MSCC
  • 6.1. Introduction
  • 6.2. Treatments for painful spinal metastases and prevention of MSCC
  • 6.3. Care of the threatened spinal cord in patients with MSCC
  • 6.4. Case selection for definitive treatment of MSCC
  • 6.5. Surgery for the definitive treatment of MSCC
  • 6.6. Radiotherapy for the definitive treatment of MSCC
  • 6.7. Health economic evaluation for treatment of MSCC
  • References
• 7. Supportive care and rehabilitation
  • 7.1. Introduction
  • 7.2. Interventions for thromboprophylaxis
  • 7.3. Management of pressure ulcers
  • 7.4. Bladder and bowel continence management
  • 7.5. Maintaining circulatory and respiratory functioning
  • 7.6. Access to specialist rehabilitation and transition to care at home
  • References
• Appendices
  • Appendix 1. An economic evaluation of extending MRI scanning hours at a district general hospital for people with suspected metastatic spinal cord compression
  • Appendix 2. An example of a patient information leaflet
  • Appendix 3. Tokuhashi scoring system: A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis
  • Appendix 4. An economic evaluation of treatments for people with suspected metastatic spinal cord compression
  • Appendix 5. Abbreviations
  • Appendix 6. Glossary
  • Appendix 7. Guideline scope
  • Appendix 8. List of topics covered by each chapter
  • Appendix 9. People and organisations involved in production of the guideline
• Evidence Review
  • Chapter 2. Service Configuration and Urgency of Treatment
  • Chapter 3. The Patient’s Experience of MSCC
  • Chapter 4. Early Detection
  • Chapter 5. Choice of Imaging
  • Chapter 6. Treatment Selection and Strategies
  • Chapter 7. Supportive Care
  • Appendix A. Literature Searches
  • Appendix B. Position Paper. Interventional Pain management in metastatic spinal cord compression
    Manohar Sharma, Consultant in Pain Medicine.
  • Appendix C. MSCC Guideline Economic Plan

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.