Acute Oncology Services Clinical Forum: Metastatic Spinal Cord Compression. Tuesday 17 th September 2013
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1 Acute Oncology Services Clinical Forum: Metastatic Spinal Cord Compression Tuesday 17 th September 2013
2 Welcome, Introduction and Aims of the Event Dr Tom Newsom-Davis, LCA AOS Pathway Chair
3 Why MSCC? Clinical Importance Improve Pathways Better Coordination Between Services Peer Review
4 Purpose of Today s MSCC Forum Understand the Current Situation Chance to Meet & Get Involved Review LCA MSCC Clinical Guidelines Agree Minimum Standards Discuss Ideal Standards Review and Comment of Subgroup s Work
5 Metastatic Spinal Cord Compression Imperial Hospitals Audit for 2012 Dr Philip Savage, Consultant Medical Oncologist, Charing Cross Hospital Imperial Hospitals, Lead Clinician for AOS
6 Metastatic Spinal Cord Compression Background Spinal cord compression is one of the most serious complications of malignancy Overall mscc is estimated to occur in ~ 2.5% of patients with advanced cancer Highest risk in patients with prostate cancer, myeloma, breast, lung and kidney cancer mscc has been subject to recent NHS/NICE/NCAT focus and service reorganisation The Imperial Hospitals mscc service was reorganised in 2010
7 Metastatic Spinal Cord Compression Background Availability of radiotherap y Spine stability Early detection & urgency of treatment NICE Key Priorities If confirmed mscc definitive treatment <24hrs mscc coordinator Imaging <24hrs of presentatio n
8 Metastatic Spinal Cord Compression Components of the Imperial system Patient Alert Cards Single contact point 24/7 for patients/gp/secondary care with potential cases of mscc All investigations and treatment centralised at CXH Spinal/neurosurgery/radiotherapy/emergency chemotherapy and 24/7 MRI and CT all on one site Weekly mscc MDT Dedicated AHP rehabilitation team
9 Metastatic Spinal Cord Compression Pre service data from our unit is very limited Published data from Scotland % of patients unable to walk unaided at diagnosis Average of 3 months back pain prior to diagnosis
10 Metastatic Spinal Cord Compression Patients Seen in 2012 Total Cases reviewed Cases with mscc % with mscc % % %
11 Metastatic Spinal Cord Compression Predominant Site of mscc Compression Cervical Spine Thoracic Spine Lumbar Spine Cauda Equina 10% 66% 21% 3%
12 Metastatic Spinal Cord Compression Oncological Diagnoses of mscc Patients Seen in 2012 pt 1 Prostate Lung Breast Kidney Bladder Lower GI CUP Myeloma Lymphoma Melanoma Plasma cytoma Head and Neck Others Total % of the total cases of mscc occurred as the presenting symptom for patients without a pre-existing cancer diagnosis In 82% of the patients with a prior cancer diagnosis, bone metastases had been previously documented
13 Metastatic Spinal Cord Compression Oncological Diagnoses pt 2 Levack 2002 Allan 2009 ICHT 2012 Lung 21% 31% 20% Prostate 21% 18% 20% Breast 17% 13% 17% Haematology 10% 8% 8% Gastrointestinal 10% 13% 5% Kidney 7% 3% 12% Unknown 7% 4% 4% Other 7% 10% 14%
14 Metastatic Spinal Cord Compression Functional Assessment at presentation Functional Assessment At Presentation At Discharge G1 Independent Mobility 21 (18%) 19 (16%) G2 Walking with an aid 23 (20%) 42 (37%) G3 Chair dependent 17 (15%) 12 (11%) G4 Bed bound 53 (47%) 28 (25%) Died in Hospital - 13 (11%) Total 114 (100%) 114
15 Metastatic Spinal Cord Compression Primary Treatment Modality Surgery Radiotherapy Chemotherapy Treated Elsewhere Symptom Control 24% 62% 2% 5% 7%
16 Metastatic Spinal Cord Compression Functional Assessment at discharge Functional Assessment At Presentation At Discharge G1 Independent Mobility 21 (18%) 19 (16%) G2 Walking with an aid 23 (20%) 42 (37%) G3 Chair dependent 17 (15%) 12 (11%) G4 Bed bound 53 (47%) 28 (25%) Died in Hospital - 13 (11%) Total 114 (100%) 114
17 Metastatic Spinal Cord Compression Functional Assessment at presentation and discharge by severity of initial impairment Outcome Overall Group 1 Group 2 Group 3 Group 4 Improved Stable Worse Died Total
18 Metastatic Spinal Cord Compression Length of Hospital Stay
19 Metastatic Spinal Cord Compression Summary Spinal cord compression remains as major cause of morbidity Over 20% of cases occur in patients with no prior cancer diagnosis The use of alert cards and increasing awareness help with earlier presentation and diagnosis A single site investigation/treatment centre assists in running mscc services Clear pathways and dedicated teams contribute to optimising treatment outcomes and reducing hospital stays
20 Acknowledgments AHP Team Libby Schofield, Davina Richardson, Nimisha Panchmatia AOS Team Philip Savage, Rachel Sharkey, Teresa Kua, Clinical Oncology Team Allison Falconer, Danni Power, Matt Williams, The SpRs Spinal Surgery Fiona Arnold, Christian Ulbricht
21 LCA MSCC Clinical Guidelines
22 Discussion on Tables: What are the Minimum and the Ideal Service Models?
23 Acute Oncology & Acute Medicine Imaging Neurosurgery Radiotherapy Palliative Medicine Therapies & Rehabilitation
24 Feedback from Groups
25 MSCC risk alert tool in EMIS Web GP systems Dr Pawan Randev GP Lead
26 Summary and next steps
27 Future Dates of Events: Tuesday 17 th December :30 19:30 Tuesday 18 th March :00 20:00
28 Thank you for attending
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