Wednesday 3rd April 2013
Helen Tyler discusses this complication and how education sessions have helped physiotherapists in South Wales.
Metastatic spinal cord compression (MSCC) is a debilitating complication of cancer that affects 5-14% people with the disease. It occurs when a primary cancer spreads to the bones of the spinal column and compresses the spinal cord, causing pain and neurological changes below the level of the compression.
Signs and symptoms of MSCC include:
-back pain, which is the most common presenting feature and may be associated with referred pain to the torso or limbs
-reduced muscle power
-bowel and bladder dysfunction.
Studies have consistently demonstrated that MSCC is diagnosed late and that a patient’s ability to walk after treatment is directly associated with the ability to walk at time of diagnosis. The prognosis of a patient with MSCC depends on their neurological status at the time of diagnosis.
Around 50% of patients with MSCC present unable to walk, and of this proportion, 80% do not regain ambulatory function. However, of the 50% who are able to walk when they present, 80% regain ambulatory function.
It is therefore imperative to diagnose this condition early to prevent irreversible neurological damage that can affect a patient’s mobility and function. Allied health professionals, particularly physiotherapists working in primary, secondary or tertiary care, will often be treating patients with the above presentations. They are often at the forefront of responding to the ‘red flags’ and making prompt and appropriate referrals before any permanent neurological damage occurs. This means that surgery can be considered, and steroid prescription and radiotherapy commenced.
In 2012, all NHS physiotherapists across the South Wales Cancer Network were invited to a one-and-half hour training session delivered by Helen Tyler and Kathryn Elias, Specialist Oncology Physiotherapists. The sessions were designed to raise awareness, deliver education and provide advice on how to manage a patient with MSCC, including the acute phase and continuing rehabilitation. Each attendee was given a self-study workbook to further develop their understanding and to share with other staff.
A total of 265 physiotherapists from the network’s six health boards attended the awareness sessions, along with a small number of other professionals. Evaluation encompassed both delivery style and pre- and post-session delegate knowledge. On a scale of 0-5, 98% of the delegates rated the delivery as ‘4’ or ‘5’, and 82-94% rated the increase in their knowledge as ‘4’ or ‘5’.
We plan to deliver the awareness sessions to GPs, district nurses and accident and emergency nurses across the network this year.
Helen Tyler, Specialist Oncology Physiotherapist and Therapies Service Manager, Velindre Cancer Centre, Cardiff.