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 121435 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.