D J Husband1. 1. Clatterbridge Centre for Oncology, Bebington, Wirral L63 4JY.
Abstract
OBJECTIVES: To examine the delay in presentation, diagnosis, and treatment of malignant spinal cord compression and to define the effect of this delay on motor and bladder function at the time of treatment. DESIGN: Prospective study of all new patients presenting to a regional cancer centre with this condition. SETTING: Regional cancer centre. SUBJECTS: 301 consecutive patients. MAIN OUTCOME MEASURES: Interval from onset of symptoms to presentation and treatment, delay at each stage of referral, and functional deterioration. RESULTS: The median (range) delay from onset of symptoms of spinal cord compression to treatment was 14 (0-840) days. Of the total delay, 3 (0-300) days were accounted for by patients, 3 (0-330) days by general practitioners, 4 (0-794) days by the district general hospital, and 0 (0-114) days by the treatment unit. Initial presentation to the regional cancer centre with symptoms of malignant spinal cord compression led to a significant reduction in delay to treatment and improved functional status at the time of treatment. Deterioration of motor or bladder function >=1 grade occurred at the general practice stage in 28% (57) and 18% (36) of patients, the general hospital stage in 36% (83) and 29% (66), and the treatment unit stage in 6% (19) and 5% (15), respectively. CONCLUSIONS: Unacceptable delay in diagnosis, investigation, and referral occurs in most patients with malignant spinal cord compression and results in preventable loss of function before treatment. Improvement in the outcome of such patients requires earlier diagnosis and treatment.
OBJECTIVES: To examine the delay in presentation, diagnosis, and treatment of malignant spinal cord compression and to define the effect of this delay on motor and bladder function at the time of treatment. DESIGN: Prospective study of all new patients presenting to a regional cancer centre with this condition. SETTING: Regional cancer centre. SUBJECTS: 301 consecutive patients. MAIN OUTCOME MEASURES: Interval from onset of symptoms to presentation and treatment, delay at each stage of referral, and functional deterioration. RESULTS: The median (range) delay from onset of symptoms of spinal cord compression to treatment was 14 (0-840) days. Of the total delay, 3 (0-300) days were accounted for by patients, 3 (0-330) days by general practitioners, 4 (0-794) days by the district general hospital, and 0 (0-114) days by the treatment unit. Initial presentation to the regional cancer centre with symptoms of malignant spinal cord compression led to a significant reduction in delay to treatment and improved functional status at the time of treatment. Deterioration of motor or bladder function >=1 grade occurred at the general practice stage in 28% (57) and 18% (36) of patients, the general hospital stage in 36% (83) and 29% (66), and the treatment unit stage in 6% (19) and 5% (15), respectively. CONCLUSIONS: Unacceptable delay in diagnosis, investigation, and referral occurs in most patients with malignant spinal cord compression and results in preventable loss of function before treatment. Improvement in the outcome of such patients requires earlier diagnosis and treatment.
Authors: F Bach; B H Larsen; K Rohde; S E Børgesen; F Gjerris; T Bøge-Rasmussen; N Agerlin; B Rasmusson; P Stjernholm; P S Sørensen Journal: Acta Neurochir (Wien) Date: 1990 Impact factor: 2.216
Authors: Zain A Husain; Arjun Sahgal; Eric L Chang; Pejman Jabehdar Maralani; Charlotte D Kubicky; Kristin J Redmond; Charles Fisher; Ilya Laufer; Simon S Lo Journal: CNS Oncol Date: 2017-07-18
Authors: Michael David Lane; Huy B Q Le; Steven Lee; Casey Young; Manraj K S Heran; Maziar Badii; Paul William Clarkson; Peter L Munk Journal: Skeletal Radiol Date: 2010-08-05 Impact factor: 2.199
Authors: F M Brooks; Ameet Ghatahora; M C Brooks; Hazel Warren; Laura Price; Pranter Brahmabhatt; Saik De Vauvert; Cerys John; Elizabeth Farnworth; Erwina Sulaiman; Sashin Ahuja Journal: Eur J Orthop Surg Traumatol Date: 2014-05-08
Authors: L Allan; L Baker; J Dewar; S Eljamel; R M Grant; J G Houston; T McLeay; A J Munro; P Levack Journal: Br J Cancer Date: 2009-05-26 Impact factor: 7.640