Abstract 394P
Background
Metastatic spinal cord compression (MSCC) is an oncological emergency which requires urgent treatment to prevent irreversible cord damage (1)(2). National Institute of Health and Care Excellence (NICE) recommends definitive treatment within 24hours of confirmed diagnosis (3).
Methods
To evaluate practice at our institute, analysis was carried out on referrals between 2014-2018, which includes 207 referrals with MSCC confirmed on imaging. Normality was assessed using Kolmogorov-Smirnov test. Kruskal-Wallis test was used to compare differences in referrals between days of the week.
Results
Commonest malignancies were sarcoma (25%), myeloma (18%), prostate (14%) & lung (11%). Previous data suggests prostate and lung cancers as commonest malignancies causing MSCC, accounting for over 50% of cases (4)(5). However, UCLH is a referral centre for sarcomas and hematological malignancies hence might explain numbers. We compared the referral numbers between Mondays and Fridays for all years combined (Table). More referrals were made on Wednesday through Friday with 57, 52 and 42 referrals respectively, p=0.134. There were less referrals on Saturday through Monday and even up to Tuesday as most referral decisions were made in the clinics. The numbers for Sunday through Tuesday were 5, 2, 21 and 28 respectively. Table: 394P
Shift in trend of referrals over three decades
| Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday | |
| Number of referrals (2014-2018) | 21 | 28 | 57 | 52 | 42 | 5 | 2 |
| Percentage of referrals (2014-2018) | 10% | 14% | 28% | 25% | 20% | 2% | 1% |
| Koiter E, 2013 (1998-2009) | 11.6% | 16.3% | 18.4% | 20.9% | 26.3% | 3.6% | 3.1% |
| Poortsmans P, 2001(1987-1997) | 12% | 17% | 15% | 20% | 30% | 5% | 1% |
A build-up and then a Friday peak of MSCC referrals as previously reported by Poortmans and then Koiter between 1987-2009. However, our data (2014-2018) shows a shift away from the Friday peak over the past 5 years. This could mean improvement in care as previous data suggests ward rounds tend to occur before weekends when treatment decisions were sometimes made. Weekend referrals still remain low across the groups.
Conclusions
The Wednesday to Friday pattern described shows a potential shift away from the ‘Friday peak’ (6)(7). Patients at our centre were treated within ≤2 days following presentation with suspicion of MSCC. This represents adherence to national guidelines (NICE) (3) in treating patients within 48hrs of suspicion of MSCC and 24hrs from a confirmed diagnosis (3). Future work will focus on assessing if the reported changes in referrals is to be found in non-specialist centres and district general hospitals across the country. This could help improve resource allocation and capacity across different days of the week depending on demand.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Department of Radiotherapy, University College Hospitals London.
Funding
Has not received any funding.
Disclosure
H.A. Payne: Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Astellas; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Janssen; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Sanofi Aventis; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Ferring; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Bayer; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Novartis. All other authors have declared no conflicts of interest.