Metastatic Spinal Cord Compression, Acute Oncology Services and Cancer of Unknown Primary EAG

Acute Oncology Services (AOS) aim to provide a co-ordinated approach to the care of cancer patients attending emergency departments (EDs) or who are admitted to hospital non-electively by another route with the following presentations:

  • Complications caused by the systemic treatment of cancer
  • Complications caused by radiotherapy
  • Complications caused by malignant disease, whether the primary site us known or unknown, and presenting as an acute problem or oncological emergency
  • Patients who present with a previously undiagnosed cancer

Patients with Cancer of Unknown Primary (CUP) usually present with metastatic disease (secondary cancer) and despite further investigation, the primary site of the cancer cannot be established.  Metastatic Spinal Cord Compression (MSCC) happens as a result of cancer spreading into or near the spine, which can then cause pressure onto the spinal cord.  There are pathways for the management of patients who present with symptoms suspicious of MSCC.  These patients are treated as a medical emergency as, if left untreated, MSCC can lead to paralysis.

Acute Oncology Services were developed in response to two reports, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2008) and a report by the National Chemotherapy Advisory Group (NCAG, 2009), along with the Measures for Cancer Services (Peer Review).  The recommendations from these reports have been embodied into the concept of Acute Oncology Services, aimed at ensuring a systematic approach is taken to dealing with cancer related emergencies.

The Acute Oncology group will be the Cancer Alliance’s primary source of advice on issues relating to Acute Oncology provision. The AOS EAG’s overall aims are to provide specialist advice and guidance to the West Midlands Cancer Alliance Board on the standards of service for patients reflecting current best practice and opportunities for development.

The AOS group and its MSCC sub-group will aim to ensure that patients receive high quality, equitable care throughout the West Midlands regardless of geography or socio-economic factors and will, wherever possible, endeavour to improve the standard of care provided.

The Acute oncology services EAG have developed Clinical Guidelines to support best practice: