Metastatic Spinal Cord Compression

Approximately 70% of cancer patients have metastatic disease at death. The spine is involved in up to 40% of those patients. Spinal cord compression may develop in 5% to 10% of cancer patients and up to 40% of patients with preexisting nonspinal bone metastasis (>25,000 cases/y). Given the increasing survival times of patients with cancer, greater numbers of patients are likely to develop this complication. The role of surgery in the management of metastatic spinal cord compression is expanding. The management of metastatic spine disease can consist of a combination of surgery, radiation treatment, and chemotherapy. Treatment modalities are not mutually exclusive and must be individualized for patients evaluated in a multidisciplinary setting.

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Nursing considerations for supporting cancer patients with metastatic spinal cord compression: a literature review

British Journal of Nursing ◽

10.12968/bjon.2019.28.17.s24 ◽

2019 ◽

Vol 28 (17) ◽

pp. S24-S29

Author(s):

Rebecca Troke ◽

Tanya Andrewes

Keyword(s):

Spinal Cord ◽

Literature Review ◽

Spinal Cord Compression ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Research Papers ◽

Patients With Cancer ◽

Nurses Role ◽

The Impact

Background: metastatic spinal cord compression (MSCC) is an oncology emergency. Prevalence is increasing. Treatment and care are complex and those diagnosed may be faced with life-changing challenges. Aims: to review the impact and management of MSCC in patients with cancer, in order to analyse nursing considerations for supporting patients. Methods: a literature review and thematic analysis of five primary research papers, published between 2009 and 2014. Findings: two themes of prognosis/survival time and independence versus dependence were discovered. Conclusions: the onset of MSCC may result in paralysis and associated loss of independence, impacting on a patient's quality of life. Understanding individuals' prognosis and treatment/care preferences is fundamental for the sensitive, individualised support of patients with MSCC. The findings reinforce the nurses' role in health education, in order to raise awareness of MSCC and promote early diagnosis so that patients maintain function and independence as long as possible. The findings support the need for nurses to be equipped with appropriate communication skills to initiate and engage in sensitive, difficult and proactive conversations with patients and their families, supporting the delivery of humanised care.

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Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review

Global Spine Journal ◽

10.1177/2192568217699189 ◽

2017 ◽

Vol 7 (3) ◽

pp. 272-279 ◽

Cited By ~ 11

Author(s):

Gordon D. Skeoch ◽

Matthew K. Tobin ◽

Sajeel Khan ◽

Andreas A. Linninger ◽

Ankit I. Mehta

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Clinical Symptoms ◽

Treatment Strategies ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Treatment Modalities ◽

High Dose ◽

Dexamethasone Treatment ◽

Corticosteroid Administration

Study Design: Narrative review. Objective: Metastatic spinal cord compression (MSCC) is a very frequent complication among cancer patients. Presenting commonly as nocturnal back pain, MSCC typically progresses to lower extremity paresis, loss of ambulatory capabilities, and paraplegia. In addition to standard treatment modalities, corticosteroid administration has been utilized in preclinical and clinical settings as adjunctive therapy to reduce local spinal cord edema and improve clinical symptoms. This article serves as a review of existing literature regarding corticosteroid management of MSCC and seeks to provide potential avenues of research on the topic. Methods: A literature search was performed using PubMed in order to consolidate existing information regarding dexamethasone treatment of MSCC. Of all search results, 7 articles are reviewed, establishing the current understanding of metastatic spine disease and dexamethasone treatment in both animal models and in clinical trials. Results: Treatment with high-dose corticosteroids is associated with an increased rate of potentially serious systemic side effects. For this reason, definitive guidelines for the use of dexamethasone in the management of MSCC are unavailable. Conclusions: It is still unclear what role dexamethasone plays in the treatment of MSCC. It is evident that new, more localizable therapies may provide more acceptable treatment strategies using corticosteroids. Looking forward, the potential for more targeted, localized application of the steroid through the use of nanotechnology would decrease the incidence of adverse effects while maintaining the drug’s efficacy.

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