1
|
Vassiliou A, Osunronbi T, Enyioma S, Rago G, Karathanasi A, Ghose A, Sheriff M, Mikropoulos C, Sanchez E, Moschetta M, Chargari C, Rassy E, Boussios S. Prognostic Factors in Patients with Metastatic Spinal Cord Compression Secondary to Lung Cancer-A Retrospective UK Single-Centre Study. Cancers (Basel) 2023; 15:4432. [PMID: 37760402 PMCID: PMC10527546 DOI: 10.3390/cancers15184432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Metastatic spinal cord compression (MSCC) is a severe complication of cancer that can lead to irreversible neurological impairment, necessitating prompt recognition and intervention. This retrospective, single-centre study aimed to determine the prognostic factors and survival rates among patients presenting with MSCC secondary to lung cancer. METHODS AND MATERIALS We identified 74 patients with epidural metastases-related spinal cord compression and a history of lung cancer through the electronic database of Medway Maritime Hospital in the United Kingdom (UK), spanning the period from April 2016 to September 2021. Among them, 39 were below 55 years old, while 35 were aged 55 years or older; 24 patients were diagnosed with small cell lung cancer (SCLC), and 50 patients had non-small cell lung cancer (NSCLC). RESULTS The median overall survival (OS) was 5.5 months, with 52 out of 74 patients dying within 6 months of diagnosis with MSCC. For the entire cohort, the statistically significant variables on multi-variate analysis were cancer type (NSCLC had improved OS), the number of involved vertebrae (one to two vertebrae involvement had improved OS), and the time taken to develop motor deficits (≤10 days to develop motor deficits had worsened OS). For the NSCLC cohort, the statistically significant variables on multivariate analysis were molecular alterations (patients with epidermal growth factor receptor (EGFR) mutation), pre-treatment ambulatory status, Eastern Cooperative Oncology Group (ECOG) performance status, and the time taken to develop motor deficits. CONCLUSIONS Within the entire cohort, patients diagnosed with NSCLC and spinal metastases affecting one to two vertebrae exhibited enhanced OS. Within the NSCLC subgroup, those with EGFR mutations who were ambulatory and possessed an ECOG performance status of 1-2 demonstrated improved OS. In both the entire cohort and the NSCLC subgroup, the development of motor deficits within a period of ≤10 days was associated with poor OS.
Collapse
Affiliation(s)
- Anna Vassiliou
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Temidayo Osunronbi
- Hull University Teaching Hospital NHS Foundation Trust, Hull HU1 3SA, UK
| | - Synthia Enyioma
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Gerardo Rago
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Afroditi Karathanasi
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Aruni Ghose
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
- Department of Medical Oncology, Barts Cancer Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London HA6 2RN, UK
| | - Matin Sheriff
- Department of Urology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK
| | - Christos Mikropoulos
- Department of Medical Oncology, St Luke’s Cancer Centre, Royal Surrey Hospital, Guildford GU1 1EB, UK
| | - Elisabet Sanchez
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Michele Moschetta
- Novartis Institutes for BioMedical Research, CH-4056 Basel, Switzerland;
| | - Cyrus Chargari
- Department of Radiation Oncology, Pitié Salpêtrière University Hospital, 75013 Paris, France;
| | - Elie Rassy
- Department of Medical Oncology, Gustave Roussy Institut, 94805 Villejuif, France;
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki–Thermi, 57001 Thessaloniki, Greece
| |
Collapse
|
2
|
Troke R, Andrewes T. Nursing considerations for supporting cancer patients with metastatic spinal cord compression: a literature review. ACTA ACUST UNITED AC 2019; 28:S24-S29. [PMID: 31556732 DOI: 10.12968/bjon.2019.28.17.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
Collapse
Affiliation(s)
- Rebecca Troke
- Registered Nurse, at time of writing BSc Hons Adult Nursing student, Bournemouth University
| | - Tanya Andrewes
- Lecturer (Academic) Adult Nursing, Bournemouth University, Bournemouth
| |
Collapse
|
3
|
Pataraia A, Crevenna R. Challenges in rehabilitation of patients with nontraumatic spinal cord dysfunction due to tumors : A narrative review. Wien Klin Wochenschr 2019; 131:608-613. [PMID: 31312916 PMCID: PMC6908546 DOI: 10.1007/s00508-019-1528-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 02/03/2023]
Abstract
The incidence of cancer-associated non-traumatic spinal cord dysfunction is rising due to population aging and better cancer treatment. The overall benefit of rehabilitation in specialized facilities for traumatic spinal cord dysfunction has been confirmed many times. Because of their fragility and multiple comorbidities cancer patients still face challenges to complete rehabilitation in the spinal rehabilitation facilities. In this narrative review we describe specific aspects, challenges in rehabilitation and opportunities to improve care. A literature search was performed in the PubMed database from 1 January 1978 to 30 November 2018. The focus was to find publications that discuss challenges and opportunities for rehabilitation of patients with non-traumatic spinal cord dysfunction due to a tumor. Most publications described the benefits of rehabilitation in specialized facilities. There were only few publications about survival and functional outcomes after rehabilitation for this patient population. Overall benefits including fewer complications associated with spinal cord dysfunction, less pain and depression, and better quality of life were shown. Within the past decades increasing number of publications revealed a growing interest for this group of patients. Despite major progress in cancer treatment, patients still have a limited vital prognosis and access to specialized rehabilitation units because of the concerns about the medical complexity. Patients with spinal cord tumors can benefit in areas of functionality, mood, quality of life, and survival from inpatient rehabilitation programs, in spite of the increased medical comorbidities.
Collapse
Affiliation(s)
- Anna Pataraia
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| |
Collapse
|
4
|
Warnock C, Hodson S, Tod A, Mills R, Crowther L, Buchanan J, Foran B. Improving care of patients with metastatic spinal cord compression. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:S14-8. [PMID: 24619048 DOI: 10.12968/bjon.2014.23.sup2.s14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Metastatic spinal cord compression is a feature of advanced cancer and the incidence is likely to increase alongside improved survival rates. Patients with spinal cord compression have complex physical, psychological and social care needs. This article describes a multidisciplinary project aimed at improving the care provided to newly diagnosed patients who were admitted to a regional cancer centre for radiotherapy. The project used a range of approaches to measure care, develop and implement interventions, and evaluate outcomes. Aspects of care reviewed in the project included mobilisation, medications including steroids and thrombo-prophylaxis, bowel management, patient priorities and concerns, discharge planning and early detection.
Collapse
Affiliation(s)
- Clare Warnock
- Practice Development Sister, Weston Park Hospital, Specialist Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Suzanne Hodson
- Senior Physiotherapist, Weston Park Hospital, Specialist Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Angela Tod
- Professor of Health Services Research, Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield
| | - Rebecca Mills
- Senior Oncology Pharmacist, Weston Park Hospital, Specialist Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Lesley Crowther
- Occupational Therapist, Weston Park Hospital, Specialist Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Jean Buchanan
- Transfer of Care Nurse, Weston Park Hospital, Specialist Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Bernadette Foran
- Clinical Oncology Consultant, Weston Park Hospital, Specialist Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| |
Collapse
|
5
|
Abstract
OBJECTIVES To assess the magnitude of management delay of pediatric malignant spinal cord compression (MSCC). METHODS Twenty-four patients with MSCC were recruited from 3 Egyptian pediatric oncology centers and assessed for MSCC clinical presentations, evaluation, and treatment response. RESULTS There was a median delay of 42 days from the onset of symptom until confirmed diagnosis. All studied patients presented inability to walk; 79% had pain (more in older patients) and 17% had sphincteric dysfunction. A total of 58.3% had a single level of cord compression, 41.7% had multiple levels. Thoracic spine was commonly involved (41%). Final diagnosis was: neuroblastoma (29.2%), soft-tissue sarcomas (20.8%), neuroectodermal tumor (16.6%), non-Hodgkin lymphoma (12.5%), astrocytoma (4.2%), malignant teratoma (8.4%), Wilms tumor (4.2%), and leukemia (4.2%). Magnetic resonance imaging of the spine was diagnostic in all cases. A total of 83.3% of patients received emergency steroid therapy and 75% showed improvement. Disease-specific therapy was multimodality therapy in 88.5% with 71.42% showing improvement. Lymphomas had the best neurological outcome (100%) followed by soft-tissue sarcomas (80%) and neural tumors (72.7%). The 3-year overall survival was 79.2%. CONCLUSIONS Spinal cord compression is a serious complication and unacceptable management delay can result in preventable loss of function. Emergency magnetic resonance imaging evaluation is the most sensitive diagnostic imaging. Majority of patients improve after definitive therapy.
Collapse
|
6
|
Abstract
CONTEXT Due to advances in acute oncological treatment, patients with spinal cord tumors exhibit improved survival. However, these patients have not received the full benefits of rehabilitation services to address their neurological deficits and rehabilitation goals. OBJECTIVE To evaluate the epidemiology and pathophysiology of spinal cord tumors, address methods of acute oncological management, review treatment for neurological sequelae, and understand the implications as they relate to rehabilitation. METHODS An extensive literature review was performed regarding the epidemiology, pathophysiology, acute oncological management, neurological sequelae, and rehabilitation for patients with spinal cord tumors. Databases used included pubmed.gov and OVID, as well as individual journal and textbook articles. RESULTS Access to treatment should be increased given improved survival and functional deficits for patients with spinal cord tumors. Individuals can benefit from inpatient rehabilitation programs, in spite of increased medical co-morbidity and neurological deficits. Specific areas of improvement include functionality, mood, quality of life, and survival. Adjustments to treatment plans must incorporate medical complications from cancer and its treatment, perceived quality of life, and prognosis. CONCLUSIONS Patients with spinal cord tumors who participate in rehabilitation programs show general improvement in function, mood, quality of life, and survival. Adaptations to care plans should be made to accommodate medical co-morbidities from cancer and its treatment, patient perceptions, and prognosis.
Collapse
Affiliation(s)
- Vishwa S. Raj
- Correspondence to: Vishwa S. Raj, Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC 28203, USA.
| | | |
Collapse
|
7
|
Warnock C, Cafferty C, Hodson S, Kirkham E, Osguthorpe C, Siddall J, Walsh R, Foran B. Evaluating the care of patients with malignant spinal cord compression at a regional cancer centre. Int J Palliat Nurs 2008; 14:510-5. [DOI: 10.12968/ijpn.2008.14.10.31496] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Clare Warnock
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christine Cafferty
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzanne Hodson
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Elizabeth Kirkham
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Charles Osguthorpe
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jan Siddall
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rebecca Walsh
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bernadette Foran
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|