4 - Determining Functional and Oncologic Prognosis and Enhancing Prognosis Discussions

Spine and spinal cord tumors are a common cause of myelopathy, accounting for up to 1/3 of non-traumatic spinal cord injury (SCI) inpatient rehabilitation admissions. As the general population ages, the incidence of cancer-related myelopathy is expected to increase. Additionally, improved cancer treatments have led to marked life expectancy increases and a greater need for coordinated cancer care. Rehabilitation service delivery must continue to evolve to keep pace with the newest cancer treatments and management of cancer survivors with chronic SCI. Multidisciplinary rehabilitation services have been shown to improve outcomes (i.e. higher functional scores, increased survival, fewer SCI complications) for patients with cancer-related myelopathy. However, there are rehabilitation barriers and challenges unique to this clinical population. Neurological impairment, oncologic prognosis/life expectancy, cancer treatments and treatment side effects, medical comorbidities, pain, and social support are factors that influence rehabilitation decisions and guide management. This component of the larger course will discuss best practices for determining prognosis, navigating difficult conversations, and enhancing communication with patients and the multidisciplinary treatment team.