PPT88 Improving recognition of malignant spinal cord compression (MSCC) in community palliative care settings: lessons learnt from audit

<h3>Background</h3> Malignant Spinal Cord Compression (MSCC) is an oncological emergency; early recognition is key for prompt investigation and treatment, though this is sub-optimal in community settings. When identified, palliative care clinicians have a central role in supporting nuanced decision-making regarding escalation, management and rehabilitation. Current national guidance presumes all patients with potential MSCC are for transfer to the acute sector. Our aim was to assess the identification of clinically suspected MSCC in community palliative care patients at risk of the condition, and whether this can be improved through audit. <h3>Methods</h3> A baseline audit of clinical notes of all community patients registered over a six-month period (November 2024 and April 2025) at one large London hospice was performed retrospectively. Patients with a higher risk of developing MSCC (myeloma, breast, lung and prostate cancer diagnoses) and new symptoms/signs associated with MSCC (including back pain and neurological deficits) were included. Documented identification of potential MSCC was recorded alongside subsequent management (MSCC coordinator contact; dexamethasone offered; MRI performed) based on NICE MSCC Guidance. Education sessions were subsequently launched alongside updated intra-departmental guidance on liaison with local MSCC coordinators; re-audit will be completed early 2026. <h3>Results</h3> The clinical records of 230 patients (with cancers at high risk of developing MSCC) were included. 45(20%) patients were identified to have a clinical suspicion of MSCC with the following malignant diagnoses: 9(20%) lung, 13(28%) breast, 22(48%) prostate and 1(4%) myeloma. Of these, 12(26%) had documented clinical suspicion of MSCC. Of these, 3(25%) were discussed with oncology/MSCC coordinator, 4(33%) had an MRI and 6(50%) received 16mg oral equivalence of dexamethasone’. <h3>Conclusions</h3> Education, localised guidance and cross-speciality service pathways may improve identification of MSCC in community palliative care settings.