Identifying and Streamlining Effective Treatment Algorithms for Cancer Pain Diagnoses with a Multidisciplinary Team

We report on utilizing a database to identify patient diagnoses, referral triggers, and treatment courses for constructing algorithms for streamlining care within a multidisciplinary medical group. The investigation into the referral systems continues to reveal different patients needing pain physician expertise for improved quality of life. In November 2017, the interventional pain clinic was established at the Vanderbilt Ingram Cancer Center. Seventy patients referred to the Vanderbilt Ingram Cancer Center for pain management from November 2017 to August 2018 were cataloged into the REDCAP database. Using this information, we analyzed the pathway of patients from referral to treatment to identify effective systems for patients to become engaged in multidisciplinary care. Once we determined a successful pathway, we began development of preliminary protocols for patients with specific diagnoses to get efficient and effective treatment from a team of physicians of different specialties. We identified and established five referral and treatment algorithms for patients with trigeminal neuralgia, radiation fibrosis, and post-thoracotomy pain. Other pathways identified included a patient with intractable abdominal pain who received intrathecal pumps and patients who benefited from palliative neurolysis. Our analysis of various treatment methods and input from different specialties broadened our scope of practice to expand our patient population. By tracking our patients from referral to treatment, we can identify effective and efficient points of care for cancer pain and establish clinical guidelines for referral and methods of treatment. This will be invaluable as a tool for establishing clinical care pathways that bridge communications between specialties to provide a higher level of comprehensive care to individual patients. References: 1) Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: Are they effective in the UK? Oncology 2006;11:935-43. 2) Haldeman S, Johnson CD, Chou R, et al. Eur Spine J 2018.