Metastatic Spinal Cord Compression WPH Macmillan Clinical Specialist Occupational Therapist in Oncology & Palliative Care Lesley Crowther
Metastatic Spinal
Cord Compression
WPH Macmillan Clinical Specialist Occupational Therapist in Oncology & Palliative Care
Lesley Crowther
Holistic assessment takes
time
Diagnosis of metastatic spinal cord
compression is a life changing event
“with a one year survival rate of less than 20%,
the majority of patients with MSCC must
manage both disability and the implications of
a life limiting illness” Eva G. Paley J. Miller M. Wee B; Palliative Medicine 2009: 23 “Patient’s construction of
disability in metastatic spinal cord compression”
MSCC – Occupational
Therapy
Aim to maintain pt at their optimum level
of functional independence to enable
their maximum quality of life
Concerned with the functional
implications of SCC symptoms and the
psychological impact that loss of role and
function can have on an individual
Occupational Therapy
National Cancer Rehab Care pathway for
MSCC recommends referral to OT within
24/48 hours of admission.
Explain role of OT and undertake initial
holistic assessment.
Discharge planning
How can MSCC patients be supported in
their discharge from hospital?
NICE clinical guideline 75
(2008)
Discharge planning and ongoing care,
including rehabilitation for patients with
MSCC, should start on day of
admission……It should involve the
patient and their families and carers….
OT - Assessment
Initial interview
To establish previous/current level of function
To discuss home environment
To discuss their functional roles i.e. father,
main family earner, carer
To ascertain what their expectations are of
treatment outcome and functional ability
OT Functional Assessment
Including physical/cognitive/psychological aspects
Functional Transfers/mobility
Feeding/drinking
Personal & domestic activities
Access/Home assessments
Leisure/hobbies/work activities
OT - Rehab
Set achievable short term goals
Provide equip for during admission
Personal/domestic activity retraining
Fatigue management and pacing
Working with carers with use & provision of equip/adaptations
Management of anxiety & relaxation
Psychological adjustment to function loss
Discharge and Post
Discharge intervention.
Support/prepare pt and carers for dc
Refer for continued rehab
Help pt optimise functional potential
Facilitate adjustment to change of ability
Continual re-assessment of function and
home environment
What options are available
on discharge?
Transfer back to local hospital
Admission to a specialist rehabilitation
unit for people who are most likely to
benefit (NICE clinical guideline 75)
Hospice
Nursing Home
Return Home
What support may be
available at home?
Informal carers
Social services
Health Services
Third (voluntary) sector services
Services differ between areas
Will I have to pay for my
care?
Patients should be assessed against continuing healthcare
criteria. Depending on level of need either social services, health
service or a joint package
HOWEVER
The WPH MSCC audit indicates that patients with little of no
mobility post treatment are likely to have a poor prognosis and
should therefore meet the continuing health care FAST TRACK
criterion:
“a primary health need arising from a rapidly deteriorating condition
which may be entering a terminal phase, with an increasing level of
dependency”
Good discharge planning
Can only happen with good
communication
Good communication with the
patient/carer cannot happen unless it
exists between all the members of the
MDT
Conclusion
OT considers the impact that MSCC
symptoms have on the person’s
functional ability. Then together problem
solve to reduce the impact and prioritise
what makes that individual’s day
purposeful to maintain quality of life.