Referral patterns and requested interventions in a cancer pain e-consult system

Chronic pain affects a substantial proportion of patients with cancer and remains undertreated despite advances in pharmacologic and interventional management. Electronic consultation (e-consult) systems have improved specialty access in other fields, yet their application to interventional cancer pain has not been described. To characterize the referral patterns and requested interventions of a dedicated interventional cancer pain e-consult platform at a large academic medical center. We conducted a single-center retrospective study of interventional cancer pain e-consults placed through the electronic health record at Massachusetts General Hospital between January 1, 2020, and December 30, 2024. Consult orders were identified via structured EHR query and underwent manual chart review. Abstracted variables included demographics, referring specialty, intervention category, mortality status, and days from referral to death. Associations between intervention category and sex or mortality were evaluated using chi-square and Fisher's exact tests. A total of 348 e-consults were included. Mean age at referral was 62 years (SD 15); sex distribution was near equal (49% male). At the time of review, 53% of patients were deceased, with a median interval from referral to death of 148 days (IQR 62–282). The most frequently requested interventions were celiac axis block (24%), spine-related procedures (16%), and opioid management (14%). Hospice and palliative medicine accounted for 53% of referrals, followed by gastrointestinal oncology (12%). Vital status at data extraction differed significantly by intervention category (p = 0.049), with celiac axis block associated with higher odds of deceased status (OR 1.76, p = 0.03) and intercostal nerve block associated with lower odds (OR 0.29, p = 0.04). A dedicated interventional cancer pain e-consult system attracted referrals spanning 19 procedural categories and multiple oncologic and palliative specialties, including a substantial proportion of patients near end of life. These findings suggest that e-consults represent a scalable, low-friction mechanism to broaden access to interventional pain expertise across the cancer care continuum.