Multidisciplinary treatment system for bone metastases for early diagnosis, treatment and prevention of malignant spinal cord compression

Abstract

Malignant spinal cord compression (MSCC) is a serious complication of cancers. The present study aimed to establish a multidisciplinary treatment system for urgent magnetic resonance imaging (MRI) and referral to orthopedists in order to prevent neurological deficits caused by MSCC. In the present study, the extent to which this system achieved early diagnosis and treatment and prevented MSCC-caused neurological deficits was examined. The records from patients with neurological deficits caused by MSCC before (between April 2007 and March 2012; group A) and after (between April 2012 and March 2017; group B) the establishment of the multidisciplinary system at the Shikoku Cancer Center (Ehime, Japan) were retrospectively evaluated. The numbers of patients with neurological deficits were 38 and 7 in groups A and B, respectively. All patients received radiotherapy. The incidence of neurological deficits was 13.2 and 3.4% in groups A and B, respectively (P<0.001). The proportion of patients with improvement in the severity of neurological deficits was 5.3 and 28.6% in groups A and B, respectively (P<0.001). The interval between physicians' recognition of a neurological deficit and MRI and the start of treatment, the number of cases, and the severity of neurological deficits were evaluated in groups A and B. The median interval between recognition of a neurological deficit by physicians and MRI was 3 and 0 days in groups A and B, respectively (P<0.001). The median interval between physicians' recognition of a neurological deficit and the start of treatment was 3 and 0 days in groups A and B, respectively (P<0.001). By using a multidisciplinary treatment system, the incidence and severity of neurological deficits following treatment were significantly improved. Therefore, the multidisciplinary treatment system used in the present study may be useful for early diagnosis, treatment and prevention of MSCC in patients with bone metastases.

Effect of Educational Program for Nurses on Clinical Outcomes of Cancer patients with Metastatic Spinal Cord Compression

“…This tool was developed by the researcher based on review of relevant literature (50) to assess the actual nursing care provided for patients with Metastatic spinal cord compression (MSCC) before and after implementation of the Educational program.…”

Association between Overall Survival and Activities of Daily Living in Patients with Spinal Bone Metastases

“…Nakata examined the usefulness of a rapid referral system to provide urgent access to MRI scanning, referral to orthopedists, and administration of RT for the urgent management of neurological deficits caused by metastatic spinal cord compression. As a result, the use of the system significantly improved the incidence and severity of neurological deficits following treatment [ 21 ]. For the effects of rehabilitation, Rief et al have shown that guided isometric training of the paravertebral muscles can be safely practiced in palliative patients with stable bone metastases of the vertebral column, improving their pain score and mobility [ 22 ].…”

Impact of a Specialized Outpatient Clinic on Bone Metastasis and Its Burden on Spine Surgeons

“…Numerous articles have called for a multidisciplinary approach to bone metastasis (3)(4)(5)(6)(7)(8)(9)(10)(11). However, most of them did not shed light on the statistical validity.…”

“…However, they did not demonstrate clinical efficacy (6). Nakata et al evaluated 45 patients with bone metastasis to the spine with paralysis, and only revealed the clinical efficacy of the multidisciplinary approach (11). They reported that the cancer board shortened the time to diagnosis and treatment, besides reducing the incidence of paralysis.…”

“…In recent years, researchers have reported on the need for a multidisciplinary approach by diverse professionals, such as orthopedic surgeons, oncologists, and radiologists. It is important to perform early intervention, such as radiotherapy, by sharing information on bone metastatic lesions using a multidisciplinary approach (3)(4)(5)(6)(7)(8)(9)(10)(11). Furthermore, a cancer board focusing on the management of bone metastases has been organized in Japan.…”