Incidence of soft tissue sarcoma and beyond

BACKGROUND:

The objectives of this study were to measure the incidence of sarcomas, including viscerally sited tumors that are not reported in cancer statistics, and to draw explanatory clues from a large and reliable sarcoma incidence data set.

METHODS:

Cases of sarcomas regardless of primary site (except bone and joints) were collected during 2 years in 3 European regions totaling approximately 26,000,000 person‐years. The sources used were pathology reports and hospital discharges forms. Diagnoses were reviewed by expert sarcoma pathologists and were classified according to 2002 World Health Organization criteria. Soft tissue sarcomas (STS) were considered those located in arms, legs, trunk, head, neck, and retroperitoneum; visceral sarcomas (VS) were considered those that arose in internal organs. Rates were age standardized using the European (ASR‐E) and the USA standard population. The rate of coexistence of VS and STS was calculated by dividing the 2 corresponding ASRs.

RESULTS:

There were 1558 sarcomas, 968 STS, and 590 VS. The ASRs‐USA per 100,000 person‐years was 5.12 × 10⁵ among males and 4.58 × 10⁵ among females for all sarcomas. For males and females, respectively, the ASR‐E per 100,000 person‐years was 3.58 × 10⁵ and 2.55 × 10⁵, respectively, for STS; 1.47 × 10⁵ and 1.97 × 10⁵, respectively, for VS; and 0.55 × 10⁵ and 0.10 × 10⁵, respectively, for Kaposi sarcoma. The coexistence rate of VS and STS was 0.41 for males and 0.77 for females. For dermatofibrosarcoma (both sexes), uterine sarcoma, liposarcoma (females), and leiomyosarcoma, including or excluding the uterus (females), the age‐specific rates depicted a curve with a rapid increasing trend until ages 40 to 50 years and little variation thereafter.

CONCLUSIONS:

Compared with the incidence of STS, VS incidence made up an additional 41% in males and 77% in females. Because the shape of age‐specific curves for some histotypes was similar to that of breast cancer, the authors concluded that sex hormones (plus many chemicals that act as endocrine disruptors) may be involved in carcinogenesis. This evidence could pave the way to investigate alternative treatments and to explore etiology. Cancer 2012. © 2012 American Cancer Society.     

‘Calling executives and clinicians to account’: user involvement in commissioning cancer services

Background

English NHS guidance emphasizes the importance of involving users in commissioning cancer services. There has been considerable previous research on involving users in service improvement, but not on involvement in commissioning cancer services.

Objective

To identify how users were involved as local cancer service commissioning projects sought to implement good practice and what has been learned.

Design

Participatory evaluation with four qualitative case studies based on semi‐structured interviews with project stakeholders, observation and documentary analysis. Users were involved in every stage from design to analysis and reporting.

Setting and participants

Four English cancer network user involvement in commissioning projects, with 22 stakeholders interviewed.

Results

Thematic analysis identified nine themes: initial involvement, preparation for the role, ability to exercise voice, consistency and continuity, where decisions are made, closing the feedback loop, assessing impact, value of experience and diversity.

Discussion

Our findings on the impact of user involvement in commissioning cancer services are consistent with other findings on user involvement in service improvement, but highlight the specific issues for involvement in commissioning. Key points include the different perspectives users and professionals may have on the impact of user involvement in commissioning, the time necessary for meaningful involvement, the importance of involving users from the beginning and the value of senior management and PPI facilitator support and training.

Conclusions

Users can play an important role in commissioning cancer services, but their ability to do so is contingent on resources being available to support them.