title: Factors that delay treatment of symptomatic metastatic extradural spinal cord compression.
abstract: BACKGROUND
  Treatment delays of metastatic extradural spinal cord compression (MESCC) sometimes have been reported, but reasons for its delay have remained unclear. The purpose of this study was to assess which clinical factors are associated with treatment delays in neurologically symptomatic MESCC in the hospital settings.
  
  
  METHODS
  We reviewed medical records of MESCC patients in our institute who had at least one progressive neurological symptom (weakness, sensory changes, urinary retention, or nerve root pain), were diagnosed by magnetic resonance imaging (MRI), and were treated with at least radiotherapy. The number of days prior to treatment initiation were counted and defined as follows: from the patients' first physician visit to our hospital until MRI diagnosis [T1 (days)], from MRI diagnosis to treatment [T2 (days)], and from patients' first visit to treatment [T1+2 (days)]. Nine clinical factors that could potentially delay treatment were analyzed for each period.
  
  
  RESULTS
  Forty-three episodes of MESCC met the inclusion criteria. Median days in T1+2 was 3 days (range: 0-22). T1 and T1+2 were significantly higher in patients with normal walking status than in those with deterioration or inabilities to walk (T1+2, 7 days versus 3 days, median, p<0.001). The number of days was higher in all periods when it included weekends (T1+2, 7 days versus 2 days, median, p<0.001).
  
  
  CONCLUSIONS
  Our findings suggest that normal walking status at the first physician visit and inclusion of weekends during the pretreatment periods were factors that resulted in treatment delays even for MESCC patients with emergency neurological symptoms.
authors.affiliation: 1 Department of Radiation Oncology, St. Luke's International Hospital , Tokyo, Japan .
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Tsukada
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakamura
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ohde
authors.forename: Keiko
authors.initials: K
authors.lastname: Akahane
authors.forename: Kenji
authors.initials: K
authors.lastname: Sekiguchi
authors.forename: Atsuro
authors.initials: A
authors.lastname: Terahara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology / Q000532:radiotherapy*; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary*; D013899:Thoracic Neoplasms / Q000473:pathology; D013997:Time Factors; D014041:Tokyo