System-Wide Oncology Service Integrates Care Across Musculoskeletal Cancers

With the appointment of Nicola Fabbri, MD, as service chief, the system-wide musculoskeletal oncology service established within the Department of Orthopedic Surgery is enabling closer cross-specialty collaboration and the advancement of novel treatments.

The system wide application of innovative, evidenced based approaches to complex musculoskeletal cancers fosters improved outcomes and survival rates across the entire NYU Langone System. One cannot do this alone, and Dr. Fabbri is fortunate to have a strong team of dedicated NYU Langone Orthopedic Oncology surgeons, including Timothy B. Rapp, MD, and Karim Masrouha, MD, to help him execute his mission.

“Optimal results come from experience—overcoming complications,” he explains. “And experience comes from volume. We are building volume exponentially in order to feed that cycle of accumulated experience and excellent outcomes.”

Teamwork Enables a ‘Menu’ of Treatment Options

A specialist in limb-preserving reconstructive surgery for bone and soft tissue cancers, Dr. Fabbri says that optimizing outcomes is not about rushing immediately toward the latest technology or drug, but depends on something more essential: teamwork.

“In orthopedic surgery, you repair a hip or a knee and that need is fulfilled in a relatively straightforward way,” he explains. “In musculoskeletal oncology, we act as restaurant owners with a larger menu of treatment options. The way we choose from that menu is undeniably through teamwork.”

While the department has long emphasized such teamwork across surgery, medical oncology, radiation oncology, and other specialties—with infrastructure to support it—Dr. Fabbri is working to further institutionalize multispecialty collaboration at a functional level. These efforts combine both the long history of excellence in orthopedic care at NYU Langone Orthopedic Hospital, and the forward-thinking treatment approaches pioneered by Perlmutter Cancer Center.

Integrating Systems Thinking in Patient Care

Several initiatives, both patient-facing and behind-the-scenes, are underway to build capacity for quality outcomes in a greater number of patients with a wider range of conditions.

Drawing on Dr. Fabbri’s expertise, a bi-weekly sarcoma conference focused on the rare bone and soft tissue tumors is now held weekly, and has been elevated across the NYU Langone network. As a result, typical participation has grown from a half-dozen specialists to more than 30 active participants—surgeons, radiation oncologists, medical oncologists, pathologists, and others who rigorously discuss cases from diagnosis and treatment through pathology.

For patients with these tumor types, a new clinic model is consolidating care to a single day’s appointments at the Perlmutter Cancer Center. At the Bone, Extremities, and Spine Tumors (BEST) clinic, patients—who often present with metastatic bone tumors secondary to breast, prostate, lung, or renal cancers—see multidisciplinary specialists in one location, easing the logistical burden of care.

Comprehensive cancer care also requires close cross-disciplinary coordination when complications arise. A physician from the orthopedic oncology service is reachable 24/7 to consult with emergency department physicians across NYU Langone campuses to ensure emergent complications are treated with the expert care they require. These include pathologic fracture of the extremities or spine, which transform a non-orthopedic cancer side effect into an orthopedic emergency— particularly in a condition such as multiple myeloma, where profuse bleeding is a risk.

“They are not your typical fractures, so we have a system-wide protocol where everyone knows how to facilitate prompt evaluation with specialists trained in managing these complexities,” says Dr. Fabbri.

Sharpening Expertise Toward Better Functional Outcomes

With the new degree of system-wide collaboration, the Department of Orthopedic Surgery is poised to build on NYU Langone’s ability to harness forward-thinking treatments and approaches and take on the most complex patients. Dr. Fabbri partners closely with experts in bone reconstruction, vascular surgery, and neurosurgery, and other specialties to offer advanced techniques such as bone transfer, limb preservation and osseointegration, and complex chordoma treatment.

“We’re thinking far beyond, ‘How do I remove this tumor safely and effectively?’ to ‘How do I work with my colleagues to help this patient meet their goals?’” he notes.

To expand the scope of the oncology service, the department also plans to add faculty with additional expertise in advanced techniques for spine and other musculoskeletal tumors. “Today, we are a modern musculoskeletal cancer center, able to treat any condition,” says Dr. Fabbri. “Tomorrow, we have ambitious plans to keep delivering high-quality outcomes to more and more complex patients.”