Malignant spinal cord compression (MSCC) is a serious condition requiring urgent palliative radiotherapy to alleviate symptoms and avoid permanent paralysis. The aim of this project was to analyse the 30-day mortality rate post-palliative radiotherapy for MSCC patients to identify if radiotherapy can be safely omitted or the fractionation reduced in the poor prognosis group (patients likely to die within 30 days) by biomarkers and performance status (PS).

A retrospective audit was performed (July–December 2019) and data on treatment duration, date of death, biomarkers (C-reactive protein (CRP), albumin) and PS were collected using hospital patient management systems.

Hundred and one patients received palliative radiotherapy for MSCC in the 6-month period. The number of patients who died within 30 days was 17, representing 16·8% mortality rate. Rising CRP levels and poor PS indicated a poorer prognosis in this patient group.

Monitoring biomarkers and PS as standard throughout patients’ treatment is recommended to assess disease progression. Worsening PS and high CRP is an indicator of poor prognosis and early death, and therefore omission of treatment or a single fraction of radiotherapy is recommended.

Malignant spinal cord compression (MSCC) is a serious condition requiring urgent palliative radiotherapy to alleviate symptoms and avoid permanent paralysis. This audit compares the number of patients treated for MSCC before and during Covid-19, their treatment regimes and 30-day mortality rates to assess if the pandemic affected the treatment and the number of patients referred for palliative radiotherapy.

A retrospective audit was performed (July–December 2019) and 101 patients were treated for MSCC, an average of 17 patients per month. A further audit was undertaken during Covid-19 (March–May 2020) and 36 patients were treated for MSCC, an average of 12 patients per month in this shorter cohort.

The results have demonstrated fewer patients presenting during the pandemic and this may be due to patients not wishing to utilise the National Health Service (NHS) during this time. It also highlighted the need to reduce the treatment duration to minimise hospital attendance and lessen the potential for exposure to Covid-19.

Educating patients at risk of MSCC is essential and all cancer patients should be counselled on symptoms and what to do if they occur. Ensuring clinicians know the warning signs and the referral pathway for MSCC is also key to ensure early presentation and early referral for treatment.