Malignant spinal cord compression

In view of the limited life expectancy for patients with MSCC, patient preferences should be paramount when deciding on treatment. The patient and their family should be provided with all relevant information, including prognosis, to allow them to make an informed decision.[40]National Institute for Health and Care Excellence. Spinal metastases and metastatic spinal cord compression. Sep 2023 [internet publication]. https://www.nice.org.uk/guidance/ng234 ​​[104]Groenen KHJ, van der Linden YM, Brouwer T, et al. The Dutch national guideline on metastases and hematological malignancies localized within the spine; a multidisciplinary collaboration towards timely and proactive management. Cancer Treat Rev. 2018 Sep;69:29-38. https://www.cancertreatmentreviews.com/article/S0305-7372(18)30090-2/fulltext http://www.ncbi.nlm.nih.gov/pubmed/29870874?tool=bestpractice.com

Advise all patients who have experienced MSCC, and their carers, about 'red flag' signs and symptoms that may indicate recurrence, and who they should contact to ensure urgent access to appropriate care.

Educate patients and their carers about daily rehabilitation techniques (e.g., stretching, muscle use), skin surveillance for breakdown, bladder care, and bowel hygiene (as applicable).

• Skin surveillance and avoidance of breakdown in numb or insensate areas involves padding at pressure points, frequent position changes, and use of emollients.

• Bladder care involves regular emptying of the bladder, which may require intermittent clean catheterisation.

• Bowel hygiene involves regular evacuation of the distal bowel, either manually, or with enemas or oral laxatives/cathartics.