Morbidity and mortality in patients with cancer who become nonambulatory after spinal cord compression: a case series on end-of-life care.

Abstract

Few studies have focused on the outcomes of nonambulatory patients diagnosed with spinal cord compression from metastatic cancer. The purpose of this study was to review the morbidity and mortality suffered by these patients. Over a 10-year period (1996-2006), a retrospective review was undertaken to assess the outcomes of 39 nonambulatory patients diagnosed with spinal cord compression from metastatic cancer. Treatment for cord compression included corticosteroids (n = 33), radiation (n = 25), and surgical decompression (n = 13). Nonetheless, 23 patients (59%) required bowel and/or bladder catheterization, and 33 (85%) required pain medications. Twenty-five (64%) did not regain ambulation. Only 13 patients (33%) went home without assistance. In contrast, 10 (26%) were transferred to a nursing home, 6 (15%) were sent home with hospice, 5 (13%) went home with home health care, and 1 (3%) was moved to a hospice inpatient facility. At the time of this report, all patients had died with a median survival of 76 days (range, 4-1975 days). Long-term survivors who lived beyond a year were primarily patients who had regained ambulation. Metastatic cord compression causes severe morbidity and compromised survival in patients who become nonambulatory. Future palliative care efforts should focus on further characterizing and addressing these needs.