Temporal Trajectories of Emotional Well-Being and Quality of Life in Patients Presenting With Metastatic Spinal Cord Compression: A Prospective Observational Study.

PurposeMetastatic spinal cord compression (MSCC) is a debilitating complication of advanced malignancies, associated with immense physical and emotional distress. The aim of this study was to assess the trajectory of emotional well-being (primary outcome) and quality of life (QoL), functional status, and pain (secondary outcomes) over 30 days.Methods106 MSCC patients were included in this prospective observational study. Assessments were done using the Hospital Anxiety and Depression Scale (HADS) for emotional well-being, EORTC QLQ-C30 for QoL, Karnofsky Performance Status (KPS) for functional status, and the numeric rating scale (NRS) for pain. These were conducted at baseline (T0), day 10 (T10), and day 30 (T30).ResultsThe mean age of the participants was 54.1 years. A V-shaped pattern was observed in emotional well-being; improvement in HADS was noted from T0 to T10 (P < 0.001), but they worsened by T30 (P < 0.01). Global health and functional domains of QoL (P < 0.05) showed improvement, but these gains plateaued as fatigue and financial distress increased. Baseline correlation weakened over time between QoL and functional domains. At T30, the only domain that remained significantly associated with QoL was emotional functioning, underscoring its strong link to overall QoL. The pain decreased significantly by day 10.ConclusionMSCC affects the emotional well-being and QoL. Initial improvements in psychological symptoms is followed by an eventual decline. There is a paradox wherein, despite objective health deterioration there is subjective improvement in well-being. Hence, a multidisciplinary approach, involving psychological and rehabilitative support, becomes crucial for optimal patient-centred care.