A multidisciplinary pain tumor board to improve QOL
Expertly addressing and improving quality of life (QOL) in patients with serious illnesses involves a team-based approach. Academic medical centers are increasingly promoting interdisciplinary boards to address the needs of patients with life-limiting diseases. Emory University established a multidisciplinary pain tumor board in April 2017 where patients are presented monthly by providers from palliative medicine, anesthesia pain, interventional radiology, psychiatry, addiction medicine, and other specialties. We present a challenging case in which various disciplines intervened as a result of this board to improve the patient’s QOL.
The patient is a 43-year-old woman with metastatic breast cancer with leptomeningeal disease on chemotherapy with physical pain secondary to osseous metastases and emotional pain secondary to existential distress and the recent suicide of her mother. Using a multidisciplinary approach to treat pain, the palliative medicine team used opiates and anticonvulsants, the anesthesia pain team performed an epidural steroid injection, and the interventional radiology team performed cryotherapy to her hip. The palliative chaplain addressed bereavement, the palliative nurse case-manager ensured prompt symptom management and open avenues of communication between her providers, and collectively her providers across disciplines coordinated a break from chemotherapy and managed her symptoms to the point where she was able to achieve her goal of travelling to Machu Picchu, Peru.
This case illustrates how academic crosstalk between disciplines can be a source of prompt, effective, and creative strategizing to improve QOL for our palliative patient population. Beyond directly addressing the QOL of our patients, we find our pain board to be a source of collegiality, education, and exposure to different disciplines committed to improving QOL. This has led to closer collaborations between our providers, from case-specific referrals to sharing patients for research collaborations. Further research is warranted to quantify direct improvements to patient care as a result of these multidisciplinary pain boards.
- Ali John Zarrabi,
- Assistant Professor of Medicine
- Emory University School of Medicine
- 1648 Pierce Dr NE
- Atlanta, GA 30309
- (404) 778-6448
- Ashima Lal
- David Prologo
- Kimberly Curseen
- Vinita Singh