New Model for Treatment Decisions in Cancer Patients with Spinal Tumors

Treating cancer patients can be a very complex process. They are often seeing multiple physicians who view things differently. In this article, a new model is proposed to help doctors plan treatment for patients with cancer. In particular, the cancer has metastasized (spread) to the cervical spine (neck). The NOMS model considers four areas: neurologic, oncologic, mechanical, and systemic disease. Most cancer patients of this type are seen by a surgeon, radiation oncologist, and medical oncologist. If every specialist treating the patient uses this model, it may be easier to see what is the best treatment choice for each patient. For example, a patient with lung cancer has severe neck pain. MRIs show the cancer has spread to the cervical spine. There is a fracture of one vertebrae and the bone has slipped forward. The traction from the movement of the bone pulls on the spinal cord. This causes pressure on the spinal cord. Using the NOMS model, the patient is assessed as follows:

Neurologic - cord compression at C5 with symptoms

Oncologic - tumor is sensitive to chemotherapy and radiation therapy

Mechanical - cervical spine is unstable

Systemic disease - the patient can handle any treatment offered The decision was made to do surgery to stabilize the spine. The fractured bone was removed. It was replaced with a titanium cage. The patient was followed up with chemotherapy. Using this model, the doctors could use a common language in discussing the patient. Each specialist could see factors they might not have considered otherwise. For example, the radiation oncologist knows the tumor will respond to radiation. But now she sees that spinal instability is a problem, too. The authors of this article present the NOMS model step-by-step and in detail. They use patient cases to show how it works. It is suggested that the NOMS model can help simplify treatment decisions for complex cancer cases. The NOMS model helps determine when to use surgery versus radiation therapy.

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