Management of malignant spinal cord compression across north-eastern Melbourne (#258)
Aims : The North-Eastern Melbourne Integrated Cancer Service (NEMICS) network has spinal surgery at one of its 4 public health services. We aimed to document the care pathway for malignant spinal cord compression (MSCC) and determine whether site of presentation impacted access to surgery.
Methods: Patients with MSCC during a 12 month period of 2011-2012 were identified from databases and retrospective review of patient records was conducted. Details of symptoms and functional status at presentation, the occurrence and timeliness of imaging, surgical and radiotherapy review and treatment, as well as patient outcomes were recorded. Patients with available data were then classified using scoring systems to identify surgical candidates: Rades (which predicts post-radiotherapy outcomes) and Tokuhashi (which predicts survival).
Results: 52 patients were audited. The proportion of MSCC managed with surgery varied (Site A (surgery site) 19/28 (68%), Site B 6/20 (30%) and Site C 2/4). Analysis of patients using key variables and scoring system data supported clinical decisions about referral to surgery. Demographics were similar across sites, however, Site B patients had poorer mobility and function at presentation. Delayed presentation was noted across all sites. Mean time from diagnosis to surgery was 4.15 days at Site A and 2.96 days for Site B patients referred to other sites for surgery.
Conclusions: Auditing variables impacting suitability for surgery informs analysis of MSCC pathway performance and equity of access to surgery. Applying scoring systems retrospectively may also assist in interpretation of data and directing service improvement activities.