Development and audit of a care pathway for the management of patients with suspected malignant spinal cord compression

Studies estimate that between 5 and 10% of patients with cancer progress to develop malignant spinal cord compression. The early management of these patients remains largely empirical. This article describes the development and results of auditing a care pathway for management of patients with malignant spinal cord compression.

Physiotherapists working in oncology and palliative care work closely with these patients throughout their admission and in the community after discharge. A frequently reported dilemma is when to mobilise a patient with malignant spinal cord compression.

Following a Master Class of specialities involved in management of patients with malignant spinal cord compression, a flow diagram was produced which was further developed into the described care pathway. Data were then collated on two groups of cord compression inpatients. Those managed prior to the use of the care pathway were compared to a second cohort of cord compression inpatients managed since implementation of the care pathway.

Results indicate that implementation of the care pathway allows earlier mobilisation of appropriate patients leading to a decreased complication rate and a significant increase in patient survival at 60 weeks. Neurological function was not compromised by implementation of the pathway. Use of the care pathway encouraged co-ordinated multi-disciplinary care.