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Metastatic spinal cord
compression
Implementing NICE guidance
2nd edition Oct 2011
NICE clinical guideline 75
NICE
Pathway
The NICE
metastatic
spinal cord
compression
pathway covers
Click here to go to
NICE Pathways
website
Related NICE guidance
• Improving outcomes for people with brain and other
CNS tumours. NICE cancer service guidance (2006)
• Improving outcomes for people with sarcoma. NICE
cancer service guidance (2006)
• Improving supportive and palliative care for adults with
cancer. NICE cancer service guidance (2004)
What this presentation covers
Background
Key priorities for implementation
Costs and savings
Discussion
Find out more
Background
MSCC is a rare complication of cancer and is usually an
oncological emergency
Some patients experience significant delays from the time when
they first develop symptoms to referral
Nearly half of all patients with MSCC are unable to walk at the
time of diagnosis
Early detection, treatment and care can reduce the risk of
developing avoidable disability and premature death
Early surgery may be more effective than radiotherapy at
maintaining mobility
Key priorities for implementation
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Service configuration and urgency of treatment
Early detection
Imaging
Treatment of spinal metastases and MSCC
Supportive care and rehabilitation
Service configuration and
urgency of treatment
Every cancer network should ensure that appropriate
services are commissioned and in place for the efficient and
effective diagnosis, treatment, rehabilitation and ongoing
care of patients with MSCC
These services should be monitored regularly through
prospective audit of the care pathway
Early detection
Inform patients with cancer who are at risk of MSCC
information about the symptoms of MSCC and what to do
and who to contact if those symptoms develop
Discuss with the MSCC coordinator
• immediately patients with cancer who have symptoms
of spinal metastases and neurological symptoms or
signs suggestive of MSCC and view as an emergency
• within 24 hours patients with cancer who have
symptoms suggestive of spinal metastases
Imaging
It is important that MRI
should be done quickly,
dependent upon signs
and symptoms
Treatment of spinal
metastases and MSCC: 1
Nurse flat with spine in neutral alignment patients with
severe mechanical pain suggestive of
• spinal instability or
• neurological symptoms or
• signs suggestive of MSCC until spinal and neurological
stability are ensured
Treatment of spinal
metastases and MSCC: 2
Start definitive treatment, if appropriate, before any further
neurological deterioration and ideally within 24 hours of the
confirmed diagnosis of MSCC
Treatment of spinal
metastases and MSCC: 3
Carefully plan surgery to maximise the probability
of preserving spinal cord function without undue
risk to the patient, taking into account their overall
fitness, prognosis and preferences
Treatment of spinal
metastases and MSCC: 4
Ensure urgent (within 24 hours) access to and
availability of radiotherapy and simulator facilities in
daytime sessions, 7 days a week, for patients with
MSCC requiring definitive treatment or who are
unsuitable for surgery
Supportive care and
rehabilitation
Start discharge planning and
ongoing care including
rehabilitation on admission
Costs and savings
Estimated cases per year in England: 3,100
Recommendations with significant costs
Estimated annual
incremental costs
resulting from increase
in surgical activity
(£000s per year)
14,023
Surgery for treatment and prevention of MSCC
Recommendations with significant savings
Savings
(£000s per year)
Supportive care and rehabilitation post
discharge of patients
-17,513
Net resource impact of MSCC guideline
-3,490
Costs correct at Nov. 2008
Costs not updated for 2nd. edition
Costs and savings
Recommendations that may result in additional costs
depending on local circumstances:
• Early diagnosis: improving access to MRI scanning services
• Treatment: increasing number of surgical procedures
Recommendations that may result in additional savings
include preventing late crisis intervention or need for
supportive care
Discussion
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How can cancer networks coordinate and audit the pathway?
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How do we ensure 24-hour availability of senior clinical
advisers in centres treating patients with MSCC?
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How do we ensure 24-hour provision of the role of MSCC
coordinator?
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How do we raise primary care awareness of significant
symptoms?
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How can we improve timeliness of referral and imaging?
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What is the current provision of community-based
rehabilitation and supportive care services and do we
need to improve this?
Find out more
Visit www.nice.org.uk/CG75 for:
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the NICE guideline
‘Understanding NICE guidance’
local patient information template
implementation advice
costing report and template
audit support
NB. Not part of presentation
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