Friday 1st July 2016
Mac Voice, the magazine for Macmillan professionals: Summer 2016
A team of Macmillan allied health professionals visited the Istituto Ortopedico Rizzoli in Bologna.
Despite clear NICE guidance, management of metastatic spinal cord compression (MSCC) remains varied and inconsistent in the UK.
The Macmillan MSCC service improvement project in the South Wales Cancer Network, which was described in a Sharing Good Practice issue in summer 2015, explored the patient pathway and has made recommendations for treatment and care.
One area of the pathway for which it has been difficult to gain a consensus of action is timely surgical opinion and intervention. In response to this, a team of three Macmillan physiotherapists and a Macmillan occupational therapist from South Wales, along with a group of four spinal surgeons, an anaesthetist and a theatre nurse, arranged a visit to the Istituto Ortopedico Rizzoli (IOR) in Bologna, Italy. The IOR has reported excellent outcomes for patients with spinal metastases and impending MSCC following an early surgical intervention.
The group was welcomed by the lead surgeons and rehabilitation professionals at the IOR. They then shared their clinical expertise through presentations and discussions about their criteria for treatment, clinical decision forums, observational surgery
and observational rehabilitation.
From an allied health professionals’ perspective, this trip highlighted the high level of clinical autonomy employed by therapists working with people diagnosed with MSCC in the UK. Despite the expertise demonstrated by the physiotherapists in the IOR, their team included a rehabilitation physiatrist whose role was to coordinate and direct rehabilitation care plans.
What we are missing here in Wales is a dedicated coordinating role which will enable provision of a streamlined, seamless service for patients with potential or confirmed MSCC. This role would provide the first point of contact for clinicians who suspect that a person may be developing MSCC. They would undertake triage assessments and facilitate investigations, transfer of care and treatment. This role would be strategic and would include advanced clinical, research/audit and educational elements.
The IOR, as with many sectors of the Italian Healthcare System, did not employ occupational therapists. The physiotherapists working there felt they would benefit from personnel who were skilled in supporting people with MSCC to regain their independence in daily activities, develop strategies to help them to re-engage with their usual occupations and enable them to fulfill their life roles. This was an opportunity for us to explain the role of occupational therapy and emphasise the importance of multidisciplinary working for making the most of potential for recovery in MSCC.
The Macmillan professionals pictured above at the IOR are grateful to Macmillan for funding this study trip. The information gathered in conjunction with the information gained by the surgeons will help to inform ongoing service innovation and development.
Contact Kate Baker and Kathryn Elias, Macmillan MSCC Service Improvement Leads, South Wales Cancer Network. Email Kate.
1. National Institute for Health and Clinical Excellence. Metastatic spinal cord compression: diagnosis and management of patients at
risk of or with metastatic spinal cord compression. Clinical guideline 75. 2008.