Suspected malignant cord compression - improving time to diagnosis via a 'hotline': a prospective audit

L. Allan, L. Baker, J. Dewar, S. Eljamel, R. M. Grant, J.G. Houston, T. McLeay, A. J. Munro, P. Levack

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    Abstract

    The aim of the study was to achieve earlier diagnosis of malignant cord compression (MCC) using urgent magnetic resonance imaging (MRI) for selected patients. A comparison was carried out of the current prospective audit of 100 patients referred by a general practitioner or a consultant over 32 months with both a previous national Clinical Research and Audit Group (CRAG) prospective audit (324 cases of MCC) and an earlier retrospective audit of 104 patients referred with suspected MCC. A telephone hotline rapid-referral process for patients with known malignancy and new symptoms (severe nerve root pain +/- severe back pain) was designed. Patients were considered for urgent MRI after discussion with a senior clinician responsible for the hotline. Appropriate referrals were discussed with radiology and oncology ensuring timely MRI reporting and intervention. The main outcome measures are as follows: time from referral to diagnosis; time from the onset of symptoms to diagnosis; and mobility at diagnosis. A total of 50 patients (52%) of those scanned had either MCC (44) or malignant nerve root compression (6) compared with the earlier rate of 23 out of 104 patients (22%). Ten out of 44 MCC patients (23%) were paralysed at diagnosis, compared with 149 out of 324 (46%) in the CRAG audit. Time from reporting pain to diagnosis was 32 days compared with 89 days in the CRAG audit. Median time from referral to diagnosis was 1 day, again considerably shorter than the CRAG audit time of 15 days (interquartile (IQ) range: 3-66). In patients at risk of MCC, fast-track referral with rapid access to MRI reduces time between symptom onset and diagnosis, improves mobility at diagnosis and reduces the number of negative MRI scans. British Journal of Cancer (2009) 100, 1867-1872. doi: 10.1038/sj.bjc.6605079 www.bjcancer.com Published online 26 May 2009 (C) 2009 Cancer Research UK

    Original languageEnglish
    Pages (from-to)1867-1872
    Number of pages6
    JournalBritish Journal of Cancer
    Volume100
    Issue number12
    DOIs
    Publication statusPublished - 9 Jun 2009

    Keywords

    • malignant spinal cord compression
    • rapid referral system
    • early diagnosis
    • QUALITY-OF-LIFE
    • CARE
    • CANCER
    • RADIOTHERAPY
    • SURVIVAL
    • SYMPTOMS
    • TRIAL

    Cite this

    Allan, L., Baker, L., Dewar, J., Eljamel, S., Grant, R. M., Houston, J. G., McLeay, T., Munro, A. J., & Levack, P. (2009). Suspected malignant cord compression - improving time to diagnosis via a 'hotline': a prospective audit. British Journal of Cancer, 100(12), 1867-1872. https://doi.org/10.1038/sj.bjc.6605079