Spinal cord Compression Outcomes Of Treatment (SCOOT) Delphi study.

Background: Earlier diagnosis, advances in medical oncology and radiation modalities continue to improve cancer patients' survival length, leading to a rise in metastatic disease and metastatic spinal cord compression (MSCC). Treatment approaches need a high level of individualisation, making management decisions for these patients challenging. Methods: A modified Delphi study with quantitative and qualitative analysis to identify thresholds for surgical intervention for MSCC patients and the factors underpinning those thresholds. A predefined expert panel was sent rounds of decision-making questionnaires on clinical vignettes of the most common primary tumours causing MSCC. The thresholds reached were based on RAND criteria and percentage agreement. Results: Twenty-four experts completed the first round, and 22 completed subsequent rounds. Experts had 312 years of experience managing MSCC patients. Spinal Instability Neoplastic Score (SINS) was the most used scoring system. The primary tumour, neurological function at presentation, functional status, and spinal lesion type were important in decision-making. Age and visceral metastasis were less important. Overall, 74% would not operate on patients paralysed at presentation, while 33% would operate within 24 hours from the onset of paralysis. The surgical intervention threshold was a visual analogue scale (VAS) of 6/10, with 82% expected to achieve pain relief. Conclusions: Treatment algorithms were constructed from the experts' responses for each primary tumour type. Indications for surgery were spinal instability and a VAS of 6/10. Major factors influencing decision-making were prognosis and pain levels. Careful consideration should be given to lung, myeloma and unknown primaries.