Quality statement 1: Information about recognising the symptoms of metastatic spinal cord compression

Quality statement

Adults at high risk of developing metastatic spinal cord compression (MSCC), and their families or carers (as appropriate), are given information that describes the symptoms of MSCC and what to do if they develop symptoms.

Rationale

It is important that adults at high risk of developing MSCC, and their families or carers (as appropriate), receive information about how to recognise the symptoms of MSCC so they can seek help to ensure prompt diagnosis and treatment. If people have information they are empowered to manage their condition, which can lead to early detection and improved outcomes. Healthcare professionals should carefully consider the timing of giving information, because adults with cancer receive a wide variety of supporting information about the disease. It is important to communicate information about MSCC clearly, and to emphasise the importance of being aware of the symptoms.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults at high risk of developing MSCC, and their families or carers (as appropriate), are given information that describes the symptoms of MSCC and what to do if they develop symptoms.

Data source: Local data collection. Department of Health Acute Oncology Measures 11‑1E‑105y (Network Information on Early Detection of MSCC) and 11‑3Y‑311 (Patient Information on Early Detection of MSCC) Manual for cancer services: acute oncology – including metatastic spinal cord compression measures (2011).

Process

Proportion of adults identified as at high risk of developing MSCC, or their families or carers, who receive information that describes the symptoms of MSCC and what to do if they develop symptoms.

Numerator – the number of adults in the denominator or their family member or carer who receive information when they are identified as at risk that describes the symptoms of MSCC and what to do if they develop symptoms.

Denominator – the number of adults identified as at high risk of developing MSCC.

Data source: Local data collection. NICE audit support for Metastatic spinal cord compression (NICE clinical guideline 75).

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that patient information about the symptoms of MSCC is available, and that healthcare professionals are trained to understand and explain the information and to give it to adults at high risk of developing MSCC, and their families or carers (as appropriate).

Healthcare professionals in both primary and secondary care ensure that they understand and can explain the patient information about the symptoms of MSCC, and that they give this information to adults at high risk of developing MSCC, and their families or carers (as appropriate).

Commissioners ensure that they commission services that provide patient information about the symptoms of MSCC, and that they train healthcare professionals to understand and explain the information and give it to adults at high risk of developing MSCC, and their families or carers (as appropriate).

What the quality statement means for patients, service users and carers

Adults at high risk of MSCC, and their families or carers (as appropriate), are given information that describes the symptoms to look out for, and advice on what to do if they notice any symptoms of MSCC developing.

Source guidance

  • Metastatic spinal cord compression (NICE clinical guideline 75), recommendation 1.3.1.1 (key priority for implementation).

Definitions of terms used in this quality statement

Adults at high risk of MSCC

Adults with cancer who have, or who are at high risk of developing, bone metastases, and adults with cancer who present with spinal pain. [Adapted from NICE clinical guideline 75 recommendation 1.3.1.1]

Adults at high risk of developing bone metastases

This group includes, but is not limited to, adults with known cancer of the lung, breast or prostate, or myeloma. The risk can be determined by identifying the tumour site, grade and stage at presentation. [Definition developed from expert consensus]

Information that describes the symptoms of MSCC

Information may be in the form of, for example, a leaflet, a 'red flag' card, or audio/visual materials. It should list the early warning symptoms of MSCC, together with clear advice on what action to take if any symptoms develop.

NICE has produced information for the public about MSCC. In addition, the full clinical guideline on MSCC includes an example of a patient information leaflet. [Definition developed from the full clinical guideline 75 appendix 2 and expert consensus]

Symptoms of MSCC

The following symptoms are suggestive of MSCC:

  • progressive pain in the spine

  • severe unremitting spinal pain

  • spinal pain aggravated by straining (for example, when passing stools, when coughing or sneezing, or when moving)

  • pain described as 'band like'

  • localised spinal tenderness

  • nocturnal spinal pain preventing sleep

  • neurological symptoms: radicular pain, any limb weakness, difficulty in walking, sensory loss, or bladder or bowel dysfunction.

[Definition developed from NICE clinical guideline 75 recommendations 1.3.2.1 and 1.3.2.2 and expert consensus]

Equality and diversity considerations

All information given about the symptoms of MSCC and what to do if symptoms develop should be accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English. Adults at high risk of developing MSCC should have access to an interpreter or advocate if needed.