Elsevier

Clinical Oncology

Volume 15, Issue 4, June 2003, Pages 211-217
Clinical Oncology

Original Article
A Population-based Study of Malignant Spinal Cord Compression in Ontario

https://doi.org/10.1016/S0936-6555(02)00400-4Get rights and content

Abstract

Design: Population-based cohort study.

Background: Malignant spinal cord compression (MSCC) has long been recognized as an important complication of cancer, but its incidence is unknown.

Objectives: To describe the incidence, the management, and the outcome of MSCC in the cancer population of the Canadian province of Ontario.

Methods: Episodes of MSCC, and treatments used for each episode, were identified by linking electronic hospital separation records and cancer centre records to Ontario's population-based cancer registry. The cumulative frequency of MSCC in the last 5 years of life was described in the 121 435 patients who died of cancer in Ontario between 1990 and 1995. Survival after the first episode of MSCC, and duration of hospitalization with MSCC, was described.

Results: The cumulative probability of experiencing at least one episode of MSCC in the 5 years preceding death from cancer was 2.5% overall, and ranged from 0.2% in cancer of the pancreas to 7.9% in myeloma. Overall, 60.2% of first episodes of MSCC were treated with primary radiotherapy, and 16.1% with surgery±postoperative radiotherapy, while in the remaining 23.7%, there was no record of radiotherapy or surgery. Overall, the median survival following the first episode of MSCC was 2.9 months. The diagnosis of MSCC was associated with a doubling of the time spent in hospital in the last year of life.

Conclusion: MSCC is a fairly common occurrence among patients dying of cancer. There is a 40-fold variation in the cumulative incidence of MSCC among different types of cancer.

Introduction

Malignant spinal cord compression (MSCC) is one of the most devastating complications of cancer, usually presenting with a history of progressive pain, paralysis, sensory loss, and loss of sphincter control 1, 2. Since Spiller's first report of rapidly developing paraplegia associated with carcinoma in 1925 [1], numerous papers have described the management and outcome of MSCC in many different types of cancer 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. However, a recent systematic review of the literature revealed no articles that describe either the incidence or the outcome of MSCC in the community at large [2]. Previous estimates of the incidence of MSCC have been based on the experience of individual institutions 15, 16, and are often confined to individual types of cancer 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. The goal of this study was to describe the burden of MSCC at the population level. In the Canadian province of Ontario, we have linked electronic records from all hospitals and cancer centres to the province's population-based cancer registry. We have previously used this database to describe various aspects of the management and outcome of cancer in Ontario 17, 18, 19, 20, 21, 22, 23. We have now used this database to describe the incidence and the management of MSCC in the cancer population at large.

Section snippets

Sources of Data

The Ontario Cancer Registry (OCR) is a population-based tumour registry, operated by Cancer Care Ontario 24, 25. The OCR routinely receives electronic records of all admissions to hospitals in Ontario in which a diagnosis of cancer is recorded; electronic reports of cancer cases registered at any of the provincial cancer centres; electronic reports of all cancer-related deaths of Ontario residents from the office of the Registrar General of Ontario; and paper reports from all pathology

Incidence of MSCC

We identified a total of 3458 patients with cancer who had at least one admission for MSCC between January 1990 and December 1995. About 57% were men. The patients' median age at the time of the first episode of MSCC was 62 years (64 years for men and 58 years for women). Lung, prostate, and breast cancer accounted for 61.2% of the cases.

In the 6-year study period, 258 069 cases of cancer were diagnosed in Ontario. Of these, only 0.23% had MSCC at the time of diagnosis, or within 2 weeks

Discussion

This study provides a unique perspective on the problem of MSCC in a population of cancer patients, but it shares the weaknesses of other studies that rely primarily on administrative data; first, much clinically important information is simply unavailable and second, the completeness and accuracy of the available data is unknown 22, 31, 32, 33. Our results should be interpreted with those problems in mind.

Although MSCC emerges here as a common problem among patients dying of cancer, we have

Acknowledgments

This work was supported in part by grants from the National Cancer Institute of Canada, and Cancer Care Ontario (WJM). The authors gratefully acknowledge the help of Dr Eric Holowaty and the Ontario Cancer Registry in providing access to their data, and much helpful advice. Dr Loblaw undertook this project while he was a Resident in Radiation Oncology at Princess Margaret Hospital. He is now a Staff Radiation Oncologist at the Toronto-Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue,

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