Metastatic spinal cord   compression Implementing NICE guidance 2008 NICE clinical guideline 75
Related NICE guidance <ul><li>This guideline is related to the following guidance:   </li></ul><ul><ul><li>Improving outco...
What this presentation covers <ul><li>Background </li></ul><ul><li>Key priorities for implementation  </li></ul><ul><li>Co...
Background <ul><li>MSCC is a rare complication of cancer and is usually an oncological emergency. </li></ul><ul><li>Some p...
Key priorities for implementation  <ul><ul><li>The areas identified as key priorities for implementation are: </li></ul></...
<ul><li>Every cancer network should ensure that appropriate  services are commissioned and in place for the efficient and ...
<ul><ul><li>Inform patients with cancer who are at risk of MSCC information about the symptoms of MSCC and what to do and ...
<ul><ul><li>It is important that MRI should be done quickly, dependent upon signs and symptoms. </li></ul></ul>Imaging
<ul><ul><li>Nurse flat with spine in neutral alignment patients with severe mechanical pain suggestive of spinal instabili...
Treatment of spinal  metastases and MSCC: 2 <ul><ul><li>Start definitive treatment, if appropriate, before any further neu...
<ul><ul><ul><li>Carefully plan surgery to maximise the probability of preserving spinal cord function without undue risk t...
Treatment of spinal  metastases and MSCC: 4 <ul><ul><ul><li>Ensure urgent (within 24 hours) access to and availability of ...
<ul><ul><li>Start discharge planning and ongoing care including rehabilitation on admission. </li></ul></ul>Supportive car...
Costs and savings Estimated cases per year in England: 3,100   Recommendations with significant costs Estimated annual inc...
Costs and savings <ul><li>Recommendations that may result in additional costs depending on local circumstances: </li></ul>...
Discussion <ul><li>How can cancer networks coordinate and audit the pathway? </li></ul><ul><li>How do we ensure 24-hour av...
Find out more <ul><li>Visit  www.nice.org.uk/CG75  for: </li></ul><ul><ul><li>the NICE guideline  </li></ul></ul><ul><ul><...
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Metastatic spinal cord compression: slide set

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Metastatic spinal cord compression: slide set

  1. 1. Metastatic spinal cord compression Implementing NICE guidance 2008 NICE clinical guideline 75
  2. 2. Related NICE guidance <ul><li>This guideline is related to the following guidance: </li></ul><ul><ul><li>Improving outcomes for people with brain and other CNS tumours. NICE cancer service guidance (2006) </li></ul></ul><ul><ul><li>Improving outcomes for people with sarcoma. NICE cancer service guidance (2006) </li></ul></ul><ul><ul><li>Improving supportive and palliative care for adults with cancer. NICE cancer service guidance (2004) </li></ul></ul>
  3. 3. What this presentation covers <ul><li>Background </li></ul><ul><li>Key priorities for implementation </li></ul><ul><li>Costs and savings </li></ul><ul><li>Discussion </li></ul><ul><li>Find out more </li></ul>
  4. 4. Background <ul><li>MSCC is a rare complication of cancer and is usually an oncological emergency. </li></ul><ul><li>Some patients experience significant delays from the time when they first develop symptoms to referral. </li></ul><ul><li>Nearly half of all patients with MSCC are unable to walk at the time of diagnosis. </li></ul><ul><li>Early detection, treatment and care can reduce the risk of developing avoidable disability and premature death. </li></ul><ul><li>Early surgery may be more effective than radiotherapy at maintaining mobility. </li></ul>
  5. 5. Key priorities for implementation <ul><ul><li>The areas identified as key priorities for implementation are: </li></ul></ul><ul><ul><li>Service configuration and urgency of treatment </li></ul></ul><ul><ul><li>Early detection </li></ul></ul><ul><ul><li>Imaging </li></ul></ul><ul><ul><li>Treatment of spinal metastases and MSCC </li></ul></ul><ul><ul><li>Supportive care and rehabilitation </li></ul></ul>
  6. 6. <ul><li>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. </li></ul>Service configuration and urgency of treatment
  7. 7. <ul><ul><li>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. </li></ul></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>Discuss with the MSCC coordinator within 24 hours patients with cancer who have symptoms suggestive of spinal metastases. </li></ul></ul>Early detection
  8. 8. <ul><ul><li>It is important that MRI should be done quickly, dependent upon signs and symptoms. </li></ul></ul>Imaging
  9. 9. <ul><ul><li>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. </li></ul></ul>Treatment of spinal metastases and MSCC: 1
  10. 10. Treatment of spinal metastases and MSCC: 2 <ul><ul><li>Start definitive treatment, if appropriate, before any further neurological deterioration and ideally within 24 hours of the confirmed diagnosis of MSCC. </li></ul></ul>
  11. 11. <ul><ul><ul><li>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. </li></ul></ul></ul>Treatment of spinal metastases and MSCC: 3
  12. 12. Treatment of spinal metastases and MSCC: 4 <ul><ul><ul><li>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. </li></ul></ul></ul>
  13. 13. <ul><ul><li>Start discharge planning and ongoing care including rehabilitation on admission. </li></ul></ul>Supportive care and rehabilitation
  14. 14. 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) Surgery for treatment and prevention of MSCC 14,023 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
  15. 15. Costs and savings <ul><li>Recommendations that may result in additional costs depending on local circumstances: </li></ul><ul><li>- Early diagnosis: improving access to MRI scanning services </li></ul><ul><li>Treatment: increasing number of surgical procedures </li></ul><ul><li>Recommendations that may result in additional savings include preventing late crisis intervention or need for supportive care. </li></ul>
  16. 16. Discussion <ul><li>How can cancer networks coordinate and audit the pathway? </li></ul><ul><li>How do we ensure 24-hour availability of senior clinical advisers in centres treating patients with MSCC? </li></ul><ul><li>How do we ensure 24-hour provision of the role of MSCC coordinator? </li></ul><ul><li>How do we raise primary care awareness of significant symptoms? </li></ul><ul><li>How can we improve timeliness of referral and imaging? </li></ul><ul><li>What is the current provision of community-based rehabilitation and supportive care services and do we need to improve this? </li></ul>
  17. 17. Find out more <ul><li>Visit www.nice.org.uk/CG75 for: </li></ul><ul><ul><li>the NICE guideline </li></ul></ul><ul><ul><li>the quick reference guide </li></ul></ul><ul><ul><li>‘ Understanding NICE guidance’ </li></ul></ul><ul><ul><li>local patient information template </li></ul></ul><ul><ul><li>implementation advice </li></ul></ul><ul><ul><li>costing report and template </li></ul></ul><ul><ul><li>audit support </li></ul></ul>

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