Malignant spinal cord compression: prospective study of delays in referral and treatment.
OBJECTIVE
To examine the delay in presentation, diagnosis, and treatment of malignant spinal cord compression and to define the effect of this delay on motor and bladder function at the time of treatment.


METHODS
Prospective study of all new patients presenting to a regional cancer centre with this condition.


METHODS
Regional cancer centre.


METHODS
301 consecutive patients.


METHODS
Interval from onset of symptoms to presentation and treatment, delay at each stage of referral, and functional deterioration.


RESULTS
The median (range) delay from onset of symptoms of spinal cord compression to treatment was 14 (0-840) days. Of the total delay, 3 (0-300) days were accounted for by patients, 3 (0-330) days by general practitioners, 4 (0-794) days by the district general hospital, and 0 (0-114) days by the treatment unit. Initial presentation to the regional cancer centre with symptoms of malignant spinal cord compression led to a significant reduction in delay to treatment and improved functional status at the time of treatment. Deterioration of motor or bladder function >=1 grade occurred at the general practice stage in 28% (57) and 18% (36) of patients, the general hospital stage in 36% (83) and 29% (66), and the treatment unit stage in 6% (19) and 5% (15), respectively.


CONCLUSIONS
Unacceptable delay in diagnosis, investigation, and referral occurs in most patients with malignant spinal cord compression and results in preventable loss of function before treatment. Improvement in the outcome of such patients requires earlier diagnosis and treatment.
Husband
D J
DJ
Clatterbridge Centre for Oncology, Bebington, Wirral L63 4JY.
D002173:Cancer Care Facilities; D006801:Humans; D009069:Movement Disorders / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation; D013117:Spinal Cord Compression / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013997:Time Factors; D001745:Urinary Bladder Diseases / Q000209:etiology