Malignant Spinal Cord Compression (MSCC) is believed to occur in
approximately 5-10% of patients with advanced cancer (Rades et al 2007),
affecting not only quality of life but also prognosis (Levack, Graham,
Kidd 2004). Studies in the last ten years have highlighted that delays
in diagnosis and referral are common and that the strongest predictor of
response to treatment is the functional status of the patient at time
of diagnosis (McLinton and Hutchison 2006).
A prospective audit (CRAG 97/98) of the diagnosis, management and
outcome of malignant cord compression reported that there were three key
reasons for delay in diagnosis:
1. A lack of recognition, by hospital doctors and General Practitioners, of the early symptoms of cord compression.
2. The absence of an efficient referral pathway for patients who are
considered to be at risk of developing, or have developed, symptoms and
signs suggestive of compression.
3. A lack of awareness of the most appropriate method of investigation to detect and manage malignant spinal cord compression.
In response to the CRAG findings and as part of the recommendations,
the South East Scotland Cancer Network has, with the help of funding
from Macmillan cancer support, developed guidelines for the early
diagnosis of malignant cord compression.
The following documents are available on the Edinburgh Cancer Centre's Online Oncology Quality System (OOQS):
- NHS Borders
- NHS Borders (Out of Hours)
- NHS Dumfries and Galloway
Policies and guidelines
- Oncology Emergency Guideline
- GP information for patients being discharged home with dexamethasone for malignant spinal cord compression
- Patient information for patients being discharged home with dexamethasone for cord compression
- Bone problems and back pain – Patient information leaflet