Introduction

This quality standard covers the early detection, diagnosis and management of metastatic spinal cord compression (MSCC) in adults (18 years and older). For more information, see the topic overview.

Why this quality standard is needed

MSCC is compression of the spinal cord and/or cauda equina by pathological vertebral collapse and/or direct tumour expansion, which may cause partial or complete loss of neurological function. MSCC is a complication of cancer and is usually considered an oncological emergency. Outcomes can be optimised using simple and rapid referral pathways, early recognition, rapid diagnosis through prompt imaging, and appropriate management, all of which aim to prevent often avoidable paralysis.

Adults with breast, lung and/or prostate cancer account for more than 50% of MSCC diagnoses. MSCC can also be caused by other tumours and haematological malignancies. Research has shown that 77% of people diagnosed with MSCC have an established diagnosis of cancer and 23% of people present with MSCC as the first presentation of their malignancy[1].

The incidence of MSCC in England is unknown because cases are not systematically recorded. However, post-mortem evidence indicates that it is present in 5–10% of people with advanced cancer. MSCC is estimated to affect approximately 3000 people annually in England[2]. The average age at the time of diagnosis is 65. It is important that care is delivered on an individualised basis and is not influenced by the age of the person.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014–15

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults

1b Life expectancy at 75

i Males ii Females

Improvement areas

1.4 Under 75 mortality rate from cancer*

i One-and ii Five-year survival from all cancers iii One-and

iv Five-year survival from breast, lung and colorectal cancer

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

i GP services

4b Patient experience of hospital care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving hospitals' responsiveness to personal needs

4.2 Responsiveness to in-patients' personal needs

Improving the experience of care for people at the end of their lives

4.6 Bereaved carers' views on the quality of care in the last 3 months of life

Improving people's experience of integrated care

4.9 People's experience of integrated care ***

5 Treating and caring for people in a safe environment and protect them from avoidable harm

Overarching indicator

5c Hospital deaths attributable to problems in care

Improvement areas

Reducing the incidence of avoidable harm

5.1 Deaths from venous thromboembolism (VTE) related events

5.3 Proportion of patients with category 2, 3 and 4 pressure ulcers

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

*** Indicator shared with Adult Social Care Outcomes Framework

Table 2 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.5 Under 75 mortality rate from cancer

Coordinated services

The quality standard for MSCC specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole MSCC care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to adults with MSCC.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality MSCC service are listed in Related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating adults with MSCC should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting adults with MSCC. If appropriate, health and social care practitioners should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.



[1] Levack P, Graham J, Collie D et al. (2001) A prospective audit of the diagnosis, management and outcome of malignant spinal cord compression. Clinical Resource and Audit Group (CRAG) 97/08