Quality standard
Quality statement 6: Radiotherapy for metastatic spinal cord compression
Quality statement 6: Radiotherapy for metastatic spinal cord compression
Quality statement
Adults with MSCC that is not suitable for surgery start radiotherapy within 24 hours of the decision to treat (if appropriate).
Rationale
Treatment while patients are still able to move or walk around is effective in maintaining their ability to walk and functional independence. Delay in treatment may have irreversible consequences, such as loss of motor and bladder functions. Starting radiotherapy as a matter of urgency is important for adults with MSCC because it can help to prevent further neurological deterioration, which may lead to complete tetraplegia or paraplegia. People who develop complete tetraplegia or paraplegia have a significantly impaired quality of life and shortened survival, so it is important to identify possible ways of preventing or improving the outcome of MSCC.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of adults with MSCC that is not suitable for surgery who start radiotherapy within 24 hours of the decision to treat (if appropriate).
Numerator – the number of adults in the denominator who start radiotherapy within 24 hours of the decision to treat.
Denominator – the number of adults with MSCC that is not suitable for surgery for whom radiotherapy is appropriate.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers ensure that for adults with MSCC that is not suitable for surgery there are local protocols in place to enable healthcare professionals to start radiotherapy (if appropriate) within 24 hours of the decision to treat.
Healthcare professionals ensure that adults with MSCC that is not suitable for surgery start radiotherapy (if appropriate) within 24 hours of the decision to treat.
Commissioners ensure that for adults with MSCC that is not suitable for surgery they commission services that can start radiotherapy (if appropriate) within 24 hours of the decision to treat.
Adults with MSCC for whom surgery is not appropriate start radiotherapy if it is suitable for them within 24 hours of the decision to start radiotherapy.
Source guidance
Spinal metastases and metastatic spinal cord compression. NICE guideline NG234 (2023), recommendations 1.1.21 and 1.10.4
Definitions of terms used in this quality statement
Adults with MSCC that is not suitable for surgery for whom radiotherapy is appropriate
Adults with MSCC that is not suitable for surgery start radiotherapy, if they wish to do so, within 24 hours unless they have had complete tetraplegia or paraplegia for 2 weeks or longer and their pain is well controlled, or their overall prognosis is poor. [Adapted from NICE's guideline on spinal metastases and metastatic spinal cord compression, recommendation 1.10.4]