Adherence to consensus-based diagnosis and treatment guidelines in adult soft-tissue sarcoma patients: a French prospective population-based study |
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| Affiliation: | 1. Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux;2. University of Bordeaux, Bordeaux;3. INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Clinical Epidemiology and Clinical Investigation Centre CIC-EC 7, Bordeaux;4. Department of Oncology, Institut Claudius Regaud, Toulouse;5. Regional Cancerology Network, Toulouse;6. Inserm CIC-EC7, Cancer Registry (Gironde) and Pole Santé Publique, CHU Bordeaux, Bordeaux;7. Tarn Cancer Registry, Albi;8. Biology–Pathology Medication Department, Institut Claudius Regaud, Toulouse;9. Department of Radiotherapy, Institut Claudius Regaud, Toulouse;11. Surgery;12. Pathology;13. Radiotherapy;14. Radiology, Institut Bergonié, Bordeaux, France |
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| Abstract: | BackgroundSoft-tissue sarcomas (STSs) are rare tumors with varied histological presentations. Management and treatment are thus complex, but crucial for patient outcomes. We assess adherence to adult STS management guidelines across two French regions (10% of the French population). We also report standardized incidence.Patients and methodsSTS patients diagnosed from 1 November 2006 to 31 December 2007 were identified from pathology reports, medical hospital records, and cancer registries. Guideline adherence was assessed by 23 criteria (validated by Delphi consensus method), and age and sex-standardized incidence rates estimated. Associations between patient, treatment, and institutional factors and adherence with three major composite criteria relating to diagnostic imaging and biopsy as well as multidisciplinary team (MDT) case-review are reported.ResultsTwo hundred and seventy-four patients were included (57.7% male, mean age 60.8 years). Practices were relatively compliant overall, with over 70% adherence for 10 criteria. Three criteria with perfect Delphi consensus had low adherence: receiving histological diagnosis before surgery, adequacy of histological diagnosis (adherence around 50% for both), and MDT discussion before surgery (adherence <30%). Treatment outside of specialized centers was associated with lower adherence for all three composite criteria, and specific tumor sites and/or features were associated with lower adherence for diagnostic imaging, methods, and MDT meetings. STS standardized incidence rates were 4.09 (European population) and 3.33 (World) /100 000 inhabitants.ConclusionsInitial STS diagnosis and treatment across all stages (imaging, biopsy, and MDT meetings) need improving, particularly outside specialized centers. Educational interventions to increase surgeon's sarcoma awareness and knowledge and to raise patients' awareness of the importance of seeking expert care are necessary. |
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