How to get oncologists to refer cancer patients for pain?

[CherubicDevil]

A cancer center opened near my practice. We implant quite a few pumps and take care of the refills and etc. Last year when they first opened, we had dinner with the director. But since then, he only referred one patient to us for a pain pump.

Any tips on getting more referrals? I understand oncologists like to "horde" their patients and just prescribe opioids even though pain specialists offer many more options. Has anyone successfully found a way for more referrals from a cancer center?

I was thinking of trying for some sort of affiliation/partnership with the new cancer center but have no experience at this sort of thing.

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[BobBarker]

I office with an oncologist. She rarely prescribes opioids in any significant quantity. The patients just aren’t there most likely.

 

[willabeast]

A cancer center opened near my practice. We implant quite a few pumps and take care of the refills and etc. Last year when they first opened, we had dinner with the director. But since then, he only referred one patient to us for a pain pump.

Any tips on getting more referrals? I understand oncologists like to "horde" their patients and just prescribe opioids even though pain specialists offer many more options. Has anyone successfully found a way for more referrals from a cancer center?

I was thinking of trying for some sort of affiliation/partnership with the new cancer center but have no experience at this sort of thing.

If the oncologist had good training, doubt there is much need for your services. 90% of my referrals from oncologists were solved with a simple med change. They usually wanted a NCeliacPB.

 

[Orin]

It takes a lot of interactions and facetime. They've got a lot of things going on and many of their patients aren't telling them about the pain/etc. Many of their pain issues are readily managed with medications as well. Those patients are train wrecks though, and they take time, energy, and it isn't like they reimburse better.

If you're looking specifically to bump up your interventional volume, I would start talking with surgical oncology types rather than medical oncology types. I would think about talking to radiation oncologists as they also have radiated patients with maintained pain. If you are focused on a large cancer center, I would see if they have a palliative team there who hears more about the pain/function issues than the oncologists, and then you just need to get them to believe in you as a physician.

 

[callmeanesthesia]

A cancer center opened near my practice. We implant quite a few pumps and take care of the refills and etc. Last year when they first opened, we had dinner with the director. But since then, he only referred one patient to us for a pain pump.

Any tips on getting more referrals? I understand oncologists like to "horde" their patients and just prescribe opioids even though pain specialists offer many more options. Has anyone successfully found a way for more referrals from a cancer center?

I was thinking of trying for some sort of affiliation/partnership with the new cancer center but have no experience at this sort of thing.

Having trained in a program that did a lot of pumps I don’t know why you’d want to deal with the hassle, but I do see why you’d want to do them for cancer pain. Consider some of the following strategies:
Request to give them a grand rounds talk on cancer pain management.
Give out your cell phone number to oncologists. Ask them to call you if they have someone in bad shape and want to get them in, along with a promise to get those patients in asap, probably within a week. For some of these patients, a three week wait may be half their remaining life.
If you have a couple cancer pain patients who had success with pumps (and are still around) ask their permission to present them as cases to the oncologists. Talk about pain, QOL, oral/transdermal medication dose reduction, and avoided hospitalizations.
Consider seeing inpatient consults. (Wouldn’t personally do this in a million years unless you have fellows to do it for you but you can also do some good for patients hospitalized with cancer pain if you can implant them as inpatients).

 

[10KHertz]

A lot of the oncologist are well versed on opioid management, rotations, sublingual options, Ritalin, Marinol, ketamine ...
The celiac blocks I offer are a headache to schedule and to clear medically. Furthermore a phenol block has mixed results esp if there are GI and hemodynamics issues.
I loved PCEA and indwelling epidural catheters, and wished more advancement in this area transpired. Due to reimbursement and lack of management compensation, the field of pain medicine in ONC is dead...too bad.
Maybe offer CAM therapies , ie acupuncture.

 

[Ferrismonk]

A lot of the oncologist are well versed on opioid management, rotations, sublingual options, Ritalin, Marinol, ketamine ...
The celiac blocks I offer are a headache to schedule and to clear medically. Furthermore a phenol block has mixed results esp if there are GI and hemodynamics issues.
I loved PCEA and indwelling epidural catheters, and wished more advancement in this area transpired. Due to reimbursement and lack of management compensation, the field of pain medicine in ONC is dead...too bad.
Maybe offer CAM therapies , ie acupuncture.

Or the random Kypho

 

[lobelsteve]

Why do they put nails in coffins?

To keep the Oncologists out.

 

[drusso]

A lot of the oncologist are well versed on opioid management, rotations, sublingual options, Ritalin, Marinol, ketamine ...
The celiac blocks I offer are a headache to schedule and to clear medically. Furthermore a phenol block has mixed results esp if there are GI and hemodynamics issues.
I loved PCEA and indwelling epidural catheters, and wished more advancement in this area transpired. Due to reimbursement and lack of management compensation, the field of pain medicine in ONC is dead...too bad.
Maybe offer CAM therapies , ie acupuncture.

When I started my career in pain I was eager to do cancer pain management and palliative care work. I met with local hospice directors and teams and I thought that I'd be putting DuPen Catheters in hospice patients and managing a gaggle of RN's on remote control for capitated payment.

But, like most in things in Pain, Cancer Pain and the DuPen Catheter were dreams of the 1990's...you could be busy all day doing that and still go broke. It's just too tempting to push a methyl acrylate into VCF's in the office, squeeze out some RVU's, knock it off early, and go to the gym.

Cancer Nurs. 1990 Jun;13(3):176-82.
Chronic cancer pain management with the Du Pen epidural catheter.
Williams AR1, Beaulaurier KE, Seal DL.
Author information
1Pain Consultation Service, Swedish Hospital Medical Center, Seattle, WA 98104.
Abstract
Chronic epidural administration of narcotics and/or local anesthetics is sometimes required in those few patients where utilization of systemic narcotics and appropriate adjuvant medications is unsuccessful in controlling intractable cancer pain. The Du Pen epidural catheter (Davol, Inc.) a silicone-based tunneled catheter modeled after the Hickman central venous catheter, has provided a safe, reliable means of long-term administration of drugs to the epidural space in over 400 patients to date. A systematic approach to the pharmacology of epidural pain control includes drug choice, bolus dosing versus infusion, volume guidelines, and titration protocols. Utilization of local anesthetics in combination with narcotics allows for enhanced pain relief in those patients refractory to narcotics as is frequently the case with neurogenic involvement. Follow-up care of patients receiving epidural narcotic with or without local anesthetic can be accomplished by a trained home cae team. Successful epidural pain management requires thorough patient and caregiver education, frequent pain assessment, and monitoring of side effects, with close collaboration between patient/family, pharmacist, home care nurse, and physician.

 

[NJPAIN]

When I started my career in pain I was eager to do cancer pain management and palliative care work. I met with local hospice directors and teams and I thought that I'd be putting DuPen Catheters in hospice patients and managing a gaggle of RN's on remote control for capitated payment.

But, like most in things in Pain, Cancer Pain and the DuPen Catheter were dreams of the 1990's...you could be busy all day doing that and still go broke. It's just too tempting to push a methyl acrylate into VCF's in the office, squeeze out some RVU's, knock it off early, and go to the gym.

Cancer Nurs. 1990 Jun;13(3):176-82.
Chronic cancer pain management with the Du Pen epidural catheter.
Williams AR1, Beaulaurier KE, Seal DL.
Author information
1Pain Consultation Service, Swedish Hospital Medical Center, Seattle, WA 98104.
Abstract
Chronic epidural administration of narcotics and/or local anesthetics is sometimes required in those few patients where utilization of systemic narcotics and appropriate adjuvant medications is unsuccessful in controlling intractable cancer pain. The Du Pen epidural catheter (Davol, Inc.) a silicone-based tunneled catheter modeled after the Hickman central venous catheter, has provided a safe, reliable means of long-term administration of drugs to the epidural space in over 400 patients to date. A systematic approach to the pharmacology of epidural pain control includes drug choice, bolus dosing versus infusion, volume guidelines, and titration protocols. Utilization of local anesthetics in combination with narcotics allows for enhanced pain relief in those patients refractory to narcotics as is frequently the case with neurogenic involvement. Follow-up care of patients receiving epidural narcotic with or without local anesthetic can be accomplished by a trained home cae team. Successful epidural pain management requires thorough patient and caregiver education, frequent pain assessment, and monitoring of side effects, with close collaboration between patient/family, pharmacist, home care nurse, and physician.

I worked with Stu DuPen at Swedish for a few months during my fellowship in 1991/92. It was a lot of work to deal with these patients with horrible cancer pain. I learned a lot about cancer from Stu in those years. Stu really had a handle on the “art” of epidural analgesia and the support of nursing and pharmacy was phenomenal. Reimbursement was good so the hospital never said no regardless of the expense associated with the therapy. As DRusso says, this type of therapy is unsustainable in today’s world unless you are at a major cancer center.






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