Quality statement 6: Treatment of metastatic spinal cord compression

Quality statement

Adults with metastatic spinal cord compression (MSCC), who present with neurological symptoms or signs, start definitive treatment (if appropriate) within 24 hours of the confirmed diagnosis.

Rationale

Treatment while patients are still able to move or walk around is effective in maintaining their ability to walk and functional independence. Delay in treatment may have irreversible consequences, such as loss of motor and bladder functions. Starting definitive treatment as a matter of urgency is important for adults with MSCC because it can help to prevent further neurological deterioration, which may lead to paraplegia. People who develop paraplegia have a significantly impaired quality of life and shortened survival, and so it is important to identify possible ways of preventing or improving the outcome of MSCC.

Quality measures

Structure

Evidence of local arrangements and written protocols to ensure that adults with MSCC who present with neurological symptoms or signs start definitive treatment (if appropriate) within 24 hours of the confirmed diagnosis.

Data source: Local data collection. Department of Health Acute Oncology Measures 11‑1E‑112y (The Audit of Timeliness of Definitive Treatment of MSCC) Manual for cancer services: acute oncology – including metatastic spinal cord compression measures (2011).

Process

Proportion of adults with MSCC who present with neurological symptoms or signs who start definitive treatment (if appropriate) within 24 hours of the confirmed diagnosis.

Numerator – the number of adults in the denominator who start definitive treatment within 24 hours of the confirmed diagnosis.

Denominator – the number of adults with MSCC who present with neurological symptoms or signs for whom it is appropriate to start definitive treatment within 24 hours.

Data source: Local data collection. Department of Health Acute Oncology Measures 11‑1E‑112y (The Audit of Timeliness of Definitive Treatment of MSCC) Manual for cancer services: acute oncology – including metatastic spinal cord compression measures (2011).

Outcome

a) Proportion of adults with MSCC who are able to walk within 3 months of treatment.

b) Proportion of adults with MSCC who are able to walk within 2 years of treatment.

c) Rates of mortality within 30 days of treatment.

Data source: Local data collection. Department of Health Acute Oncology Measures 11‑1E‑113y Manual for cancer services: acute oncology – including metatastic spinal cord compression measures (2011). British Spine Registry Spinal tumour data (2013).

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

Service providers ensure that for adults with MSCC presenting with neurological symptoms or signs adequate capacity is available and that there are local protocols in place to enable healthcare professionals to start definitive treatment (if appropriate) within 24 hours of the confirmed diagnosis.

Healthcare professionals ensure that for adults with MSCC who present with neurological symptoms or signs they start definitive treatment (if appropriate) within 24 hours of the diagnosis being confirmed.

Commissioners ensure that for adults with MSCC who present with neurological symptoms or signs they commission services that can start definitive treatment (if appropriate) within 24 hours of the confirmed diagnosis.

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

Adults with MSCC for whom treatment is appropriate start their treatment as quickly as possible (ideally within 24 hours of being diagnosed with MSCC).

Source guidance

Definitions of terms used in this quality statement

Definitive treatment

Definitive treatment for MSCC includes surgery and radiotherapy. [Department of Health Acute Oncology Measures (The Audit of Timeliness of Definitive Treatment of MSCC) Manual for cancer services: acute oncology – including metatastic spinal cord compression measures (2011)]

Symptoms and signs of MSCC

The following symptoms and signs are suggestive of MSCC:

  • progressive pain in the spine

  • severe unremitting spinal pain

  • spinal pain aggravated by straining (for example, at stool, 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.

  • neurological signs of spinal cord or cauda equina compression.

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

Equality and diversity considerations

Survival times for adults with MSCC vary from just a few weeks to over a decade. The person's age should not affect the decision to undertake definitive treatment.