System-level implementation of a multidisciplinary spine oncology pathway.

75 Background: Multidisciplinary (MD) cancer care benefits patients, providers, and health systems, especially in spine oncology (SO), where delays, miscommunication, and inappropriate referrals can affect outcomes. In 2014, an MD team of spine surgeons, medical oncologists, radiation oncologists, and radiologists (SOaR 2 ) established a literature-based care pathway for patients with spinal malignancies. The program aimed to reduce treatment time, simplify diagnosis and therapy, improve collaboration, and optimize resources, with the goal of becoming a center of excellence. The pathway is regularly updated to meet evolving stakeholder needs. Objective: To develop and implement a SO program that enhances MD care for patients with spinal tumors. Methods: Patients with symptoms suggestive of spinal malignancy were evaluated across the five hospitals of an academic health system. A rapid MRI protocol with reserved daily slots, optimized sequences, and a novel SO imaging score (SOIS) reporting protocol for instability risk and spinal cord compression with automatic electronic notification (AEN) was created to promptly identify oncologic emergencies. Rapid-access clinics in radiation oncology and neurosurgery provided expedited CT simulation and urgent outpatient evaluations, minimizing emergency department use and unnecessary hospital admissions. Stable patients were reviewed at the MD SO tumor board, where discussions focused on diagnosis confirmation, spinal stability, neural compression, and systemic therapy. Consensus recommendations were distributed electronically to each member of each individual patient care team. Patients were co-evaluated by radiation oncology and neurosurgery in an MD spine clinic. CT/MRI simulation for radiation therapy (RT) or surgical intervention was guided by consensus and shared decision-making. Postoperative patients were appropriately reassessed for adjuvant RT. RT was delivered using conventional or stereotactic body radiation therapy (SBRT). A standardized RT workflow was implemented, supported by a dedicated spine SBRT planning team, including credentialed physicians and physicists. A six-degree-of-freedom couch improved treatment precision. Results: SOIS adoption has been robust, with nearly 3,500 reports issued since 2021. AEN of MRI results were associated with earlier SO visits and treatments. Growth was observed in the SBRT program between FY24 and FY25: consultations increased from 79 to 111 (141%), treated patients from 104 to 163 (157%), and treatment sessions from 255 to 464 (182%). Average time from symptom onset to safe community return was reduced from multiple months to 6–8 weeks. Conclusions: A dedicated MD SO program improved care coordination, accelerated time-to-treatment, and enhanced resource utilization for patients with spinal malignancies. Continued system integration will support the growing demands of this complex population.