Digital Platform Cuts Bone Metastasis Treatment Decision Time

A structured digital communication platform reduced the time to multidisciplinary treatment recommendation for patients with bone metastases from 24 hours to under two hours, a greater than 90 percent reduction, according to research presented at the 2026 annual meeting of the American Society for Radiation Oncology.

The platform, called NIMBLE (Network for the Integrated Management of Bone Metastases: Linking Experts), replaces the traditional weekly tumor board model with a secure, real-time digital system that connects radiation oncologists, orthopedic surgeons, interventional radiologists and other specialists the moment a patient is referred.

“Historically, multidisciplinary decision-making has depended on a tumor board that meets once a week. We developed NIMBLE because we felt there had to be a better way to bring the right specialists together quickly, make a coordinated recommendation and move the patient toward the appropriate care without unnecessary delays,” says Meena Bedi, MD, staff member in the Department of Radiation Oncology at Cleveland Clinic Cancer Institute.

Overcoming decision delays

For patients with bone metastases, a multidisciplinary approach to treatment decisions is essential. Under traditional workflows, that coordination is structured around a fixed weekly tumor board meeting, and a patient referred on a Thursday might not receive a recommendation until the following week, with consultation and treatment scheduling extending the timeline further.

In patients with advanced cancer, even short delays can impact outcomes. Among the 127 patients studied, each additional day of delay before treatment was associated with approximately a 6 percent decrease in overall survival, even after controlling for other factors.

“The association between treatment delay and survival was one of our most important findings. Although we cannot establish causation, it reinforces the point that time matters for patients with advanced cancer. If we can eliminate unnecessary delays in care, we should,” Dr. Bedi explains.

How NIMBLE works

From September 2023 to April 2024, 127 consecutive patients were referred to a newly established bone metastasis program. Eighty-one percent were managed through NIMBLE, while the remaining 19 percent were handled through the standard weekly tumor board workflow. Patient and tumor characteristics were comparable between the two groups.

The contrast in timelines was substantial. Median time from intake to a multidisciplinary treatment recommendation was 1.9 hours with NIMBLE versus 24 hours with the traditional approach. Time from intake to radiation consultation was significantly shorter at 8 days versus 18 days. A trend toward earlier treatment initiation, 22 days versus 38 days, did not reach statistical significance.

Patients in the NIMBLE cohort were recommended for conservative management more often: 67 percent versus 33 percent in the standard workflow group. Researchers attribute that finding to improved triage, as the platform’s rapid, coordinated review helped identify patients who did not need an intervention and spared them from unnecessary consultations.

One of the most important findings was that better coordination did not lead to more procedures or more radiation. “In many cases, it allowed us to determine that an intervention was not necessary. For a patient with metastatic cancer who may already be dealing with pain and a tremendous appointment burden, avoiding an unnecessary consultation has value. The goal is not to treat more patients, rather to identify the right treatment for the right patient at the right time,” says Dr. Bedi.

A different kind of innovation

The NIMBLE findings point to a dimension of cancer care improvement that gets less attention than new therapeutics: operational design. The platform uses data infrastructure to shorten the interval between intake and interdisciplinary discussion from up to a week to fewer than 24 hours.

This reduced interval allows radiation oncology programs to manage increasingly complex caseloads in a more agile manner. Patients with metastatic cancer are living longer, and the volume of bone metastasis referrals is growing. Scalable solutions like NIMBLE help maintain care quality across that volume.

“NIMBLE shows that innovation in cancer care does not always require a new drug or treatment device,” says Dr. Bedi. “Other centers could adapt this type of model using secure communication infrastructure and defined multidisciplinary workflows. The key is moving from a meeting-centered model to a patient-centered model, where the discussion occurs when the patient needs it rather than when the next meeting is scheduled.”

The team plans to validate these findings in a larger population and better understand how shortening the time to multidisciplinary decision-making affects downstream outcomes, including time to treatment, resource utilization, patient experience and survival outcomes. The goal is to create a model of multidisciplinary care that is both more efficient and more responsive to the individual patient