Metastatic Spinal

Cord Compression

WPH Macmillan Clinical Specialist Occupational Therapist in Oncology & Palliative Care

Lesley Crowther

Holistic assessment takes

time

Diagnosis of metastatic spinal cord

compression is a life changing event

“with a one year survival rate of less than 20%,

the majority of patients with MSCC must

manage both disability and the implications of

a life limiting illness” Eva G. Paley J. Miller M. Wee B; Palliative Medicine 2009: 23 “Patient’s construction of

disability in metastatic spinal cord compression”

MSCC – Occupational

Therapy

Aim to maintain pt at their optimum level

of functional independence to enable

their maximum quality of life

Concerned with the functional

implications of SCC symptoms and the

psychological impact that loss of role and

function can have on an individual

Occupational Therapy

National Cancer Rehab Care pathway for

MSCC recommends referral to OT within

24/48 hours of admission.

Explain role of OT and undertake initial

holistic assessment.

Discharge planning

How can MSCC patients be supported in

their discharge from hospital?

NICE clinical guideline 75

(2008)

Discharge planning and ongoing care,

including rehabilitation for patients with

MSCC, should start on day of

admission……It should involve the

patient and their families and carers….

OT - Assessment

Initial interview

To establish previous/current level of function

To discuss home environment

To discuss their functional roles i.e. father,

main family earner, carer

To ascertain what their expectations are of

treatment outcome and functional ability

OT Functional Assessment

Including physical/cognitive/psychological aspects

Functional Transfers/mobility

Feeding/drinking

Personal & domestic activities

Access/Home assessments

Leisure/hobbies/work activities

OT - Rehab

Set achievable short term goals

Provide equip for during admission

Personal/domestic activity retraining

Fatigue management and pacing

Working with carers with use & provision of equip/adaptations

Management of anxiety & relaxation

Psychological adjustment to function loss

Discharge and Post

Discharge intervention.

Support/prepare pt and carers for dc

Refer for continued rehab

Help pt optimise functional potential

Facilitate adjustment to change of ability

Continual re-assessment of function and

home environment

What options are available

on discharge?

Transfer back to local hospital

Admission to a specialist rehabilitation

unit for people who are most likely to

benefit (NICE clinical guideline 75)

Hospice

Nursing Home

Return Home

What support may be

available at home?

Informal carers

Social services

Health Services

Third (voluntary) sector services

Services differ between areas

Will I have to pay for my

care?

Patients should be assessed against continuing healthcare

criteria. Depending on level of need either social services, health

service or a joint package

HOWEVER

The WPH MSCC audit indicates that patients with little of no

mobility post treatment are likely to have a poor prognosis and

should therefore meet the continuing health care FAST TRACK

criterion:

“a primary health need arising from a rapidly deteriorating condition

which may be entering a terminal phase, with an increasing level of

dependency”

Good discharge planning

Can only happen with good

communication

Good communication with the

patient/carer cannot happen unless it

exists between all the members of the

MDT

Conclusion

OT considers the impact that MSCC

symptoms have on the person’s

functional ability. Then together problem

solve to reduce the impact and prioritise

what makes that individual’s day

purposeful to maintain quality of life.