Expedited multidisciplinary pain management in patients with metastatic cancer.

319 Background: Pain from metastatic cancer is often debilitating, undertreated, and requires multimodality care. Unfortunately, complex coordination and scheduling limitations can delay treatment. We implemented a pilot program that expedited pain management for patients with metastatic cancer experiencing significant pain. Methods: A rapid pain response team (RPRT) was assembled, including medical, radiation and supportive oncology. Patients with metastatic cancer who reported a pain score of 7 or higher out of 10 to their oncologist were referred to the RPRT pilot for consultation with supportive and radiation oncology within 48 hours. The pilot included patients with metastatic cancer, primarily lung, breast and prostate cancers. Patients who received multimodality care were followed, with pain scores and opioid use tracked weekly for four weeks after the last radiation treatment. Results were compared to a retrospective control cohort of patients with metastatic cancer who had a radiation oncology consultation in 2023 and a pain score of 7 or greater. Differences between the groups were analyzed using a Student’s t-test. Results: Between September 2024 and April 2025, 27 patients were enrolled in the pilot. Most were male (N = 15) with a median age of 65 years old (41-90) and had non-small cell lung cancer (N = 17). Eighteen patients received multimodality care, 15 of which completed 4 week follow-up. The control group included 29 patients, of which 13 received multimodality care, and 16 had pain scores available 4 weeks after radiation. The mean time from referral to supportive oncology and radiation oncology consultation was significantly decreased in pilot patients, 0.4 vs 11.7 days (p < 0.001), and 1.3 vs 8.0 days (p < 0.001) respectively. The mean time from referral to the start of radiotherapy was also significantly shorter in the pilot, 6.7 vs 27.6 days (p < 0.001). The mean initial pain scores were similar between cohorts, pilot 8.6 vs control 8.1 (p = 0.07). For pilot and control patients who had pain scores available at 4 weeks after radiation, final pain scores also were similar, 1.9 pilot vs 2.9 control (p = 0.36). In the pilot, pain scores decreased during the 4 weeks after radiation. Patients’ mean pain scores were 4.5 at week 1, 3.1 at week 2, 2.9 at week 3 and 1.9 at week 4. For pilot patients who completed follow up, 6 (40%) patients had stable opioid use, 9 (60%) patients had decreased opioid use, 4 (26.7%) of which discontinued all opioid use. Conclusions: Compared to the control cohort, patients in this pilot experienced expedited pain relief and on average started radiation 3 weeks earlier from time of referral. Further, pilot patients reported pain score improvement and stable to decreased use of opioids by 4 weeks post radiation. Given the limited life expectancy of this population, prompt pain management is extraordinarily valuable.