Oncological Emergencies Dr. Gary Harding md, frcpc

Treatment delays…….

• 2 month median delay in treatment from onset of back pain11

• 14 day delay in treatment from onset of neurological symptoms11

Why the delay?

• Patient factors

• General practitioner factors

• Hospital factors

• EDUCATION

Treatment Objectives

• Pain control

• Avoidance of complications

• Preserve or improve neurological function

Pain management

• Corticosteroids

• Decrease edema

• Opiates

• Needed to decrease pain for comfort and examination purposes

Bed Rest

• No

• No

• No

• No

Anticoagulation

• Cancer is a hypercoaguable state

• High burden of tumor in metastatic disease

• Possible value in prophylaxis against venous thromboembolism

• If patient not mobile subcutaneous heparin or compression devices is indicated

Prevention of Constipation

• Factors

• Autonomic dysfunction
• Limited mobility
• Opiate analgesic

• Risk of perforation

• Masked by corticosteroids

• Bowel regimen needed

Corticosteroids

Part of standard regimen

• Part of standard regimen

• Limited data on benefit vs. side effects

• Many studies suggesting lower doses can be effective

• No randomized trials

Corticosteroid Recommendations

• High dose dexamethasone and half dose every three days

• Pain with minimal neurological dysfunction can have lower dose

• Small asymptomatic lesions can forgo steroids

Radiation Therapy

Definitive choice

•