References
Nursing considerations for supporting cancer patients with metastatic spinal cord compression: a literature review
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.
Metastatic spinal cord compression (MSCC) may be a life-changing complication of advanced cancer and an oncology emergency (Bowers, 2015; Al-Qurainy and Collis, 2016). MSCC is defined as compression of the spinal cord or cord equina by metastatic or direct spread of a malignancy to the vertebrae (Farrell, 2013; National Institute for Health and Care Excellence (NICE), 2019). It is an oncology emergency because it may cause neurological impairment, but prompt treatment while the patient remains ambulant results in maintenance of the ability to walk in 80-100% of cases (London Cancer, 2012).
Although spinal cord compression may be non-malignant in origin and present in people with or without cancer, MSCC can be the first presentation of an undiagnosed primary cancer that has progressed, or may reflect secondary disease (Wanman et al, 2017). Any cancer has the potential to metastasise to the spine, but MSCC most commonly presents in breast, lung and prostate cancer, lymphoma and myeloma. Advances in cancer treatment have resulted in higher long-term survival rates, therefore the risk of developing MSCC is increasing (Bowers, 2015; Spratt et al, 2017). Signs of MSCC centre on spinal pain and neurological symptoms, as summarised in Table 1.
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