Sylvester Launches One of the Nation’s First Tumor Boards Dedicated to Cancer Pain
Summary
- Sylvester’s Adult Cancer Pain & Bone Metastasis Tumor Board is moderated by the Department of Interventional Radiology.
- The board brings together specialists from fields including palliative care, radiation oncology, orthopedic and spine surgery, neurosurgery, anesthesia, pain medicine and medical oncology.
- This initiative aims to improve the quality of life for cancer patients by addressing their pain with the same urgency as the cancer itself.
The launch of a pioneering tumor board focused exclusively on cancer-related pain is a bold step toward improving quality of life for cancer patients at Sylvester Comprehensive Cancer Center, part of UHealth – University of Miami Health System. The board particularly focuses on bone metastases, a leading cause of cancer-related pain. It’s one of the first of its kind in Florida and among only a handful in the United States.
“The Adult Cancer Pain & Bone Metastasis Tumor Board meets regularly with a group of specialists to discuss the management for patients with symptoms that are typically not discussed on most tumor boards,” explained Laurence Sands, M.D., M.B.A., professor and chair of the DeWitt Daughtry Family Department of Surgery at the University of Miami Miller School of Medicine and interim chair of its Department of Interventional Radiology.
The board, which began meeting in May 2025, brings together a multidisciplinary team of specialists to streamline specialized, individualized pain management strategies for patients whose symptoms often fall outside the scope of traditional oncology or palliative care boards. Within just over a month of its first meeting, the team had already reviewed and developed care plans for more than 25 patients.
Treating Cancer Pain as Urgently as the Disease
“This initiative is driven by the belief that we should treat cancer pain with the same urgency and collaboration as the cancer itself,” said Alan Alper Sag, M.D., associate professor of interventional radiology at the Miller School and cofounder of the board. “We’re combining two increasingly relevant topics — cancer pain and bone metastases — into a focused, multidisciplinary approach that can dramatically improve patient outcomes. I am especially grateful to our current chair, Dr. Laurence Sands, for his support in building on this vision.”
Before joining the University of Miami, Dr. Sag represented Duke University on the National Comprehensive Cancer Network (NCCN) Guidelines Panel for Adult Cancer Pain and is nationally recognized in bone and nerve interventions.
“Dr. Sag is an interventional radiologist and a national leader in bone and nerve interventions,” Dr. Sands noted. “His vision in creating this multidisciplinary team, the first such program in the state of Florida and among a select few in the United States, will improve the quality of life for many of our patients.”
A Dedicated Multidisciplinary Cancer Pain Board
Unlike conventional boards that focus primarily on cancer treatment, the cancer pain tumor board dives deeper into pain-specific strategies, guided by the NCCN Adult Cancer Pain guidelines. The goal is to deliver faster, more effective relief, enabling patients to continue their treatment regimens without interruption.
“The tumor board allows patients to have an expert opinion from a wide range of disciplines in a fast and efficient manner,” explained Gregory J. Kubicek, M.D., a clinical professor of radiation oncology at the Miller School.
Moderated by members of the Department of Interventional Radiology, the board includes core members from palliative care, radiation oncology, orthopaedic and spine surgery, neurological surgery, anesthesia, pain medicine and medical oncology. This diverse team meets regularly to review complex cases submitted via secure email, with each member contributing their unique clinical lens. The board discusses patients across the University of Miami and Jackson Health systems.
“These specialties typically work in tandem, but it is quite unique to have a dedicated, multidisciplinary conference that aims to streamline and synchronize cancer pain treatment plans,” said Amanda Rivera, M.D., assistant professor and director of brachytherapy in the Miller School’s Department of Radiation Oncology.
Faster Relief From Bone Metastasis Pain
One standout case involved a young patient whose severe pelvic pain from metastatic colon cancer persisted despite exhausting radiotherapy and opioid escalation. Participants in a cancer pain tumor board conference identified two additional pain-directed options: a focal outpatient CT-guided nerve block and ablation and an intrathecal pain pump. The patient underwent CT-guided intervention and experienced immediate, complete pain relief.
“Cancer-related pain, especially from bone metastases, has been reactively managed for several years and often relied on heavy opioid use,” said Marvin Mesa, MSN, NP-C, a medical oncology advanced practice nurse practitioner. “I have seen how this truly multidisciplinary team can think creatively, act quickly and prioritize comfort without compromising patient cancer treatment.”
In another case, a patient with kidney cancer that had metastasized to the spine benefited from a collaborative plan involving surgery, radiation and interventional radiology to decompress the spinal cord and manage escalating pain.
“Our model accelerates time to decision for the patient by integrating specialists to rapidly align on multimodal pain strategies for our patients,” said Dr. Sag. “It’s about preserving quality of life and ensuring patients can stay on track with their cancer care.”
Improved Quality of Life for Cancer Patients
While the cancer pain tumor board is still in its early stages, Dr. Sag says it may help reduce opioid use, hospital admissions for cancer pain crises and cancer treatment interruptions.
Other board participants noted the potential to influence survival and improve quality of life. Alan Pollack, M.D., Ph.D., chair emeritus and professor of radiation oncology at the Miller School, said, “The new cancer pain tumor board heightens awareness among referring faculty for new and/or underutilized techniques that directly address quality-of-life issues and indirectly may influence survival.”
Patients have responded with gratitude and relief.
“For many, this is the first time they’ve seen an entire team come together to focus solely on their cancer pain,” said Dr. Sag. “It builds confidence and trust in the care we deliver.”
Sylvester’s board is one of the few such boards in the country. Emory University and Brown University were among the earliest to implement them.
“We believe this approach will become standard at major cancer centers,” Dr. Sag said. “Our advice to others: Build a motivated, collaborative team and let the shared mission of relieving suffering guide your innovation.”
The Adult Cancer Pain & Bone Metastasis Tumor Board meets on Wednesdays from 7:15 a.m. to 7:45 a.m. via secure Zoom. Email Dr. Sag with questions.
Tags: Department of Interventional Radiology, DeWitt Daughtry Family Department of Surgery, Dr. Alan Sag, Dr. Laurence Sands, interventional radiology, pain management, Sylvester Comprehensive Cancer Center, tumor board