Team Effort

Novel UF Health collaborative uses better communication to treat cancer pain

Ajay Antony, M.D., left, and Stephen Vose, M.D., lead a collaborative at UF Health that aims to provide pain treatment for end-of-life patients and those with unbearable pain.

Ajay Antony, M.D., left, and Stephen Vose, M.D., lead a collaborative at UF
Health that aims to provide pain treatment for end-of-life patients and those
with unbearable pain.

By Kacey Finch

Julie Bondurant’s tumor pain changed her life. She took a medical leave from her job early in 2018, started taking antidepressants, lost 50 pounds from
inactivity, and began to give up.

“The pain consumed me,” said Bondurant, 33, who had been the general manager of an Olive Garden restaurant. “I literally spent every second of every day in my recliner hurting and only getting up to go to the bathroom and doctors’ appointments.”

Bondurant was diagnosed with a rare tumor called a desmoid on her shoulder. While benign, these tumors are treated with chemotherapy and radiation if they continue to grow. The tumor can infiltrate anything in its way, including connective tissues and nerves.

In May, Bondurant’s pain turned constant and severe. Her oncologist, Joanne Lagmay, M.D., an associate professor in the UF College of Medicine’s department of pediatrics, tried to treat her using opioids and steroid injection, but nothing would touch the never-ending pain.

Lagmay contacted Stephen Vose, M.D., and Ajay Antony, M.D., both assistant professors in the UF College of Medicine’s department of anesthesiology. Vose and Antony were residents together in UF’s anesthesiology program.

Now, they are combining their skillsets to provide pain treatment for end-of-life patients and those with unbearable pain like Bondurant.

Vose and Antony started the UF Health Cancer and Palliative Pain Collaborative, or CPPC, in 2015. This unique arrangement provides patients suffering from cancer-related pain “world-class expedited pain modalities when time matters most,” Vose said.

One aspect of cancer therapy that is often overlooked is pain, Antony said. “Pain management can be accomplished in many different ways.”

The typical way to treat pain is to deliver medications in pill or patch form. However, other methods such as surgically implanted pumps that deliver pain medicine, known as intrathecal drug delivery, or nerve blocks can control pain better without the side effects and limitations of opioid medications.

UF Health has expert physicians in a variety of disciplines who are able to perform these pain-relief procedures and therapies, but Antony said communication among physicians treating cancer-related pain was inefficient. “The unique aspect of this multidisciplinary initiative is the communication tool in Epic,” said Antony, referring to the electronic medical records software system used at UF Health Shands and other health systems. “That is how we have most
effectively been able to identify the problem and potential solutions to collectively come up with a comprehensive plan for the patient.”

The novel communication tool in Epic was developed by Vose and allows communication within a small network of physicians who can formulate a care plan online and execute it in a timely and efficient manner.

“It’s a really good way to actually be able to get a response quickly because everybody reads their Epic messages,” said Lagmay, director of the pediatric solid tumor program at UF Health. “Other specialists who are able to treat pain can chime in and partake in the conversation in real time and give ideas of how to make the pain better quickly.”

On Sept. 10, Antony surgically implanted in Bondurant a spinal cord stimulator, one of several advanced minimally invasive techniques used by UF physicians to treat complex pain syndromes.

“It was extremely successful,” Bondurant said. “I could tell immediately, as soon as they turned it on.”

Treating a patient’s pain crisis is the first step to fixing anything else, Lagmay said. New treatment options have relieved pain in over 20 of her patients.

“Having this resource and their expertise really makes us better able to serve our patients,” she said. “We’ve been able to have patients die with more dignity because their pain is under control. That means a lot.”

In this arrangement, the patient comes first, said Vose.

“I want the patient to be the center of this,” he said. “That was very important to me: to provide expedited assistance when time matters the most and provide exceptional availability to all oncologists.”

Since the beginning, the collaborative has had no funding, Vose said. With funding, he said, they could upgrade the Epic communication tool, hire a nurse to put on rounds specifically for pain management and be present at tumor board meetings, and take the idea to big cancer centers nationwide.

“We feel this is a scalable model that is transferrable to different institutions,” he said. “Everybody has cancer programs; not everybody has cancer pain programs.”

Currently, around 30 physicians are a part of the collaborative, Vose said. The one thing he asks is that all members are willing.

“I think we’re all trying to save someone, and I think all of us have the personal stories and personal reasons we go into this,” Vose said. “I think we always want to do better than we did before.”