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- Talk
- 19/06/2025
- UK
Palliative care and its role in the management of metastatic spinal disease
Description
Victoria Bradley, a palliative medicine consultant in Oxford, explains the role of palliative care for patients with spinal metastatic disease. She outlines the history of modern palliative care and hospice care, emphasising its origins with Cicely Saunders and how it evolved into a largely charity-funded service in the UK. She describes palliative care’s core functions: advance care planning and holistic symptom assessment, and explains how the specialty has shifted from a late, reactive model to a needs-based approach that can improve quality of life and even survival.
Bradley challenges common misconceptions that palliative care is only about end-of-life bedside comfort, instead showing that it aims to add life to days through practical, patient-centered support. She gives vivid examples of individualised care, such as bringing an elephant, horses, or cows to hospices, helping a young patient get to the cinema, and even learning a child’s question about a doctor’s favourite dinosaur. These stories illustrate how palliative care focuses on what matters to the person, not just their disease.
She then describes a new multidisciplinary metastatic bone disease team in Oxford, developed to address fragmented care for symptomatic patients who do not fit standard pathways for cord compression or fractures. The team meets weekly in a flexible virtual format and includes interventional radiology, surgery, oncology, and palliative care, with additional input from other specialists as needed. A structured pro forma helps the team consider the patient, lesion, and personal priorities, not just the imaging or diagnosis.
Bradley reports early outcomes from the service: improved symptom control, faster access to interventions, preserved or improved performance status, and strong collaboration across specialties. She hopes to develop an in-person polyclinic where patients can be seen jointly by relevant specialists. In the Q&A, she discusses MDT fatigue, the value of keeping meetings informal and collaborative, and the importance of multi-professional rather than purely medical teams. She also notes that physician associates are not currently used in her setting but could potentially contribute.