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Walker K, Simister SK, Carr-Ascher J, Monument MJ, Thorpe SW, Randall RL. Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas. J Surg Oncol 2024; 129:97-111. [PMID: 38010997 DOI: 10.1002/jso.27526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
In this special edition update on soft tissue sarcomas (STS), we cover classifications, emerging technologies, prognostic tools, radiation schemas, and treatment disparities in extremity and truncal STS. We discuss the importance of enhancing local control and reducing complications, including the role of innovative imaging, surgical guidance, and hypofractionated radiation. We review advancements in systemic and immunotherapeutic treatments and introduce disparities seen in this vulnerable population that must be considered to improve overall patient care.
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Affiliation(s)
- Kyle Walker
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Samuel K Simister
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Janai Carr-Ascher
- Department of Hematology and Oncology, University of California, Davis, Sacramento, California, USA
| | - Michael J Monument
- Department of Surgery, The University of Calgary, Calgary, Alberta, Canada
| | - Steven W Thorpe
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - R Lor Randall
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
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2
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Schärer M, Heesen P, Bode-Lesniewska B, Studer G, Fuchs B. Benchmarking Time-to-Treatment Initiation in Sarcoma Care Using Real-World-Time Data. Cancers (Basel) 2023; 15:5849. [PMID: 38136394 PMCID: PMC10741448 DOI: 10.3390/cancers15245849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Benchmarking is a fundamental tool for enhancing quality within a patient-centered healthcare framework. This study presents an analysis of time-to-treatment initiation (TTI) for sarcoma patients, utilizing a database encompassing 266 cases from the Swiss Sarcoma Network. Our findings indicate a median TTI of 30 days across the cohort, with bone sarcomas and deep soft tissue sarcomas demonstrating a shorter median TTI of 28 days, followed by superficial soft tissue sarcomas at 42 days. The data reveal that the use of real-world-time data (RWTD) may account for a longer TTI observed, as it offers more comprehensive capture of patient journeys, unlike conventional datasets. Notably, variability in TTI was observed between different treatment institutions, which underscores the need for standardized processes across centers. We advocate for a selective referral system to specialized centers to prevent capacity overload and ensure timely treatment initiation. Our analysis also identified significant delays in TTI for unplanned 'whoops'-resections, highlighting the importance of early specialist referral in optimizing treatment timelines. This study emphasizes the potential benefits of a streamlined, data-informed approach to sarcoma care. However, further research is required to establish the direct impact of integrated care models on TTI and patient outcomes in the context of sarcoma treatment.
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Affiliation(s)
- Markus Schärer
- Sarcoma Service, Department of Orthopaedics and Trauma, University Teaching Hospital LUKS, 6000 Lucerne, Switzerland;
- Health Sciences and Medical Faculty, University of Lucerne, 6001 Lucerne, Switzerland
- Sarcoma Service, Department of Orthopaedics and Trauma, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Philip Heesen
- Sarcoma Service, University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland;
| | | | - Gabriela Studer
- Health Sciences and Medical Faculty, University of Lucerne, 6001 Lucerne, Switzerland
| | - Bruno Fuchs
- Sarcoma Service, Department of Orthopaedics and Trauma, University Teaching Hospital LUKS, 6000 Lucerne, Switzerland;
- Health Sciences and Medical Faculty, University of Lucerne, 6001 Lucerne, Switzerland
- Sarcoma Service, University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland;
- Pathologie Institut Enge, University of Zurich, 8000 Zurich, Switzerland
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3
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Fuchs B, Schelling G, Elyes M, Studer G, Bode-Lesniewska B, Scaglioni MF, Giovanoli P, Heesen P. Unlocking the Power of Benchmarking: Real-World-Time Data Analysis for Enhanced Sarcoma Patient Outcomes. Cancers (Basel) 2023; 15:4395. [PMID: 37686671 PMCID: PMC10486409 DOI: 10.3390/cancers15174395] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Benchmarking is crucial for healthcare providers to enhance quality and efficiency, notably for complex conditions like sarcomas. Multidisciplinary teams/sarcoma boards (MDT/SBs) are vital in sarcoma management, but differences in their processes can affect patient outcomes and treatment costs, despite adherence to international guidelines. To address this issue, this study aimed to compare two MDT/SBs and establish an interoperable digital platform, Sarconnector®, for real-time-world data assessment and automated analysis. The study included 983 patients, 46.0% of whom female, with a median age of 58 years, and 4.5% of patients presented with metastasis at diagnosis. Differences were observed in the number of first-time presentations, follow-up presentations, primary sarcomas, biopsies and chemotherapy indications between the two MDT/SB. The results highlight the importance of benchmarking and utilizing a harmonized data approach, such as the RWT approach provided by the Sarconnector®, to standardize and evaluate quality and cost metrics. By identifying areas of improvement and making data-driven decisions on the meta-level, healthcare providers can optimize resources and improve patient outcomes. In conclusion, benchmarking with the RWT harmonized data approach provided by the Sarconnector® can help healthcare providers improve the overall effectiveness of the healthcare system and achieve better outcomes for their patients in terms of both outcomes and costs.
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Affiliation(s)
- Bruno Fuchs
- Sarcoma Service, University Teaching Hospital LUKS, University of Lucerne, 6000 Lucerne, Switzerland
- University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland
- Sarcoma Service, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Georg Schelling
- Sarcoma Service, University Teaching Hospital LUKS, University of Lucerne, 6000 Lucerne, Switzerland
- Sarcoma Service, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Maria Elyes
- Sarcoma Service, University Teaching Hospital LUKS, University of Lucerne, 6000 Lucerne, Switzerland
| | - Gabriela Studer
- Sarcoma Service, University Teaching Hospital LUKS, University of Lucerne, 6000 Lucerne, Switzerland
| | - Beata Bode-Lesniewska
- Patho Enge, SSN Reference Sarcoma Pathology, University of Zurich, 8000 Zurich, Switzerland
| | - Mario F. Scaglioni
- Sarcoma Service, University Teaching Hospital LUKS, University of Lucerne, 6000 Lucerne, Switzerland
| | - Pietro Giovanoli
- University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland
| | - Philip Heesen
- University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland
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4
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Jakob J, Andreou D, Bedke J, Denschlag D, Dürr HR, Frese S, Gösling T, Graeter T, Grünwald V, Grützmann R, Hoffmann J, Juhasz-Boess I, Kasper B, Kogosov V, Knoefel WT, Lehner B, Lehnhardt M, Lindner LH, Matthies C, Sehouli J, Ugurel S, Hohenberger P. Ten recommendations for sarcoma surgery: consensus of the surgical societies based on the German S3 guideline "Adult Soft Tissue Sarcomas". Langenbecks Arch Surg 2023; 408:272. [PMID: 37430129 PMCID: PMC10333354 DOI: 10.1007/s00423-023-03002-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE The evidence-based (S3) guideline "Adult Soft Tissue Sarcomas" (AWMF Registry No. 032/044OL) published by the German Guideline Program in Oncology (GGPO) covers all aspects of sarcoma treatment with 229 recommendations. Representatives of all medical specialties involved in sarcoma treatment contributed to the guideline. This paper compiles the most important recommendations for surgeons selected by delegates from the surgical societies. METHODS A Delphi process was used. Delegates from the surgical societies involved in guideline process selected the 15 recommendations that were most important to them. Votes for similar recommendations were tallied. From the resulting ranked list, the 10 most frequently voted recommendations were selected and confirmed by consensus in the next step. RESULTS The statement "Resection of primary soft tissue sarcomas of the extremities should be performed as a wide resection. The goal is an R0 resection" was selected as the most important term. The next highest ranked recommendations were the need for a preoperative biopsy, performing preoperative MRI imaging with contrast, and discussing all cases before surgery in a multidisciplinary sarcoma committee. CONCLUSION The evidence-based guideline "Adult Soft Tissue Sarcomas" is a milestone to improve the care of sarcoma patients in Germany. The selection of the top ten recommendations by surgeons for surgeons has the potential to improve the dissemination and acceptance of the guideline and thus improve the overall outcome of sarcoma patients.
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Affiliation(s)
- Jens Jakob
- Sarcoma Unit, Department of Surgery and Mannheim Cancer Center, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68135, Mannheim, Germany.
| | - Dimosthenis Andreou
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Jens Bedke
- Department of Urology, Klinikum Stuttgart, Stuttgart, Germany
| | - Dominik Denschlag
- Department of Gynecology, Hochtaunus-Kliniken gGmbH, Bad Homburg, Germany
| | - Hans Roland Dürr
- Orthopaedic Oncology, Department of Orthopaedics and Trauma Surgery, LMU Klinikum, University Hospital, LMU Munich, Munich, Germany
| | | | - Thomas Gösling
- Department of Trauma and Orthopedic Surgery, Clinical Center Braunschweig, Braunschweig, Germany
| | - Thomas Graeter
- Thoracic Surgery, SLK-Lungenklinik Lowenstein, Lowenstein, Germany
| | - Viktor Grünwald
- Clinic for Urology, Clinic for Medical Oncology, University Hospital Essen, Essen, Germany
| | - Robert Grützmann
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Bavaria, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingolf Juhasz-Boess
- Department of Gynecology, Obstetrics and Reproductive Medicine, University of Freiburg Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Vlada Kogosov
- Comprehensive Cancer Center Göttingen G-CCC, University Medical Center Göttingen, Georg August University, Göttingen, Germany
- CCC-N (Comprehensive Cancer Center Lower Saxony), Göttingen, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Burkhard Lehner
- Department of Orthopaedics, Section Orthopedic Oncology and Septic Orthopedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité Comprehensive Cancer Center, University Medicine Berlin, Berlin, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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5
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Strönisch A, Märdian S, Flörcken A. Centralized and Interdisciplinary Therapy Management in the Treatment of Sarcomas. Life (Basel) 2023; 13:life13040979. [PMID: 37109507 PMCID: PMC10144040 DOI: 10.3390/life13040979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Sarcoma treatment requires a high level of expertise due to its rarity and heterogeneity. Sarcoma patients should, therefore, be referred to an expert centre as early as possible to ensure optimal treatment. Numerous studies have been carried out to provide evidence for this strategy. In compliance with the 2020 PRISMA guidelines, a systematic search was conducted in PubMed, EMBASE, Ovid Medline, ClinicalTrials.gov and Cochrane Library databases. The subject of these studies was the centralised treatment of adult sarcoma patients at expert centres and the use of interdisciplinary tumour boards. Uncertainty in therapy, delays in referral to expert centres, and limited access to therapeutic modalities continue to be a challenge in sarcoma therapy. At expert centres, diagnostic procedures were more frequently and adequately performed, and treatment was associated with an improvement in outcomes in the majority of studies: patients benefited from longer survival, lower local recurrence rates and a better postoperative outcome. The implementation of an interdisciplinary tumour board was associated with discrepant results. In a greater number of studies, it was associated with a lower local relapse rate, better overall survival and surgical outcome. In two studies, however, a shorter overall survival was observed. The establishment of expert centres and the consistent use of interdisciplinary tumour boards are important structures for ensuring multidisciplinary therapy approaches. There is growing evidence that this holds great potential for optimising sarcoma therapy.
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Affiliation(s)
- Annika Strönisch
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anne Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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6
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Mosku N, Heesen P, Christen S, Scaglioni MF, Bode B, Studer G, Fuchs B. The Sarcoma-Specific Instrument to Longitudinally Assess Health-Related Outcomes of the Routine Care Cycle. Diagnostics (Basel) 2023; 13:diagnostics13061206. [PMID: 36980513 PMCID: PMC10047519 DOI: 10.3390/diagnostics13061206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Patient-based health related quality of life (HRQoL) measurements are associated with an improvement in quality of care and outcomes. For a complex disease such as sarcoma, there is no disease-specific questionnaire available which covers all clinically relevant dimensions. Herein, we report on the development of an electronically implemented, sarcoma-specific instrument to assess health-related outcomes, which encompasses a combination of generic questionnaires tailored to the respective disease and treatment status covering the entire longitudinal care cycle. An interoperable digital platform was designed to provide a node between patients and physicians and to integrate the sarcoma-specific HRQoL instrument with patient and physician-based quality indicators to allow longitudinal structured real-world-time data evidence analytics. This approach enables the prediction modeling of disease, and by attributing cost tags to quality indicators, treatment effectiveness for a given disease will be directly correlated with financial expenses, which may ultimately lead to a more sustainable healthcare system.
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Affiliation(s)
- Nasian Mosku
- Department of Plastic & Reconstructive Surgery, University of Grenoble, 38000 Grenoble, France
| | - Philip Heesen
- Department of Plastic & Reconstructive Surgery, University of Zurich, 8091 Zurich, Switzerland
| | - Salome Christen
- Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
| | - Mario F Scaglioni
- Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
- University Teaching Hospital LUKS Lucerne Sarcoma Surgery, University of Lucerne, 6000 Lucerne, Switzerland
| | - Beata Bode
- Patho Enge, University of Zurich, 8000 Zurich, Switzerland
| | - Gabriela Studer
- Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
- University Teaching Hospital LUKS Lucerne Sarcoma Surgery, University of Lucerne, 6000 Lucerne, Switzerland
| | - Bruno Fuchs
- Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
- University Teaching Hospital LUKS Lucerne Sarcoma Surgery, University of Lucerne, 6000 Lucerne, Switzerland
- Kantonsspital Winterthur (KSW), 8400 Winterthur, Switzerland
- University Hospital Zurich (USZ), 8000 Zurich, Switzerland
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7
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Pizzato M, Collatuzzo G, Santucci C, Malvezzi M, Boffetta P, Comandone A, Levi F, La Vecchia C, Bertuccio P, Negri E. Mortality patterns of soft-tissue sarcomas worldwide up to 2018, with predictions for 2025. Eur J Cancer Prev 2023; 32:71-80. [PMID: 36346699 DOI: 10.1097/cej.0000000000000768] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The epidemiological evidence on soft-tissue sarcoma (STS) mortality is inconsistent in geographic and time coverage. This study provides mortality trends for STSs in selected countries worldwide over the last 2 decades, together with predicted figures for 2025. METHODS We extracted official numbers of certified deaths coded as C47 (i.e. malignant neoplasm of peripheral nerves and autonomic nervous system) and C49 (i.e. malignant neoplasm of other connective and soft tissue) according to the 10th Revision of the International Classification of Disease and population estimates from the WHO and the Pan American Health Organization databases. We computed age-standardized (world standard population) mortality rates (ASMRs). We used joinpoint regression analysis to identify significant changes in trends and to predict death numbers and rates for 2025. RESULTS The pattern emerging from the number of deaths and ASMRs up to 2018 shows an increase in most countries in both sexes. Around 2015 to 2018, ASMRs differed by 2.5-fold in both sexes with the highest rates being registered in Central-Eastern Europe, North America and Australia, while the lowest ones in Latin America, Japan, and Korea. In 2025, the number of STS deaths is predicted to increase in most countries and both sexes, and unfavourable rates are predicted in Central Europe in both sexes. CONCLUSION In addition to improvements in STSs registration, unfavourable mortality rates reported in this study reflect inadequate referral of patients with STSs to high-volume multidisciplinary centres, as well as insufficient advancements in STS prevention, diagnosis, and treatments.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Matteo Malvezzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
| | | | - Fabio Levi
- Department of Epidemiology and Health Services Research, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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8
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Blay JY, Italiano A, Penel N, Le Loarer F, Karanian M, De Pinieux G, Coindre JM, Ducimetiere F, Chemin C, Morelle M, Gouin F, Toulmonde M, Le Cesne A. Impact d’un réseau de centre de référence pour le diagnostic et la prise en charge des patients atteints de sarcomes en France depuis 2010. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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9
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Heesen P, Studer G, Bode B, Windegger H, Staeheli B, Aliu P, Martin-Broto J, Gronchi A, Blay JY, Le Cesne A, Fuchs B. Quality of Sarcoma Care: Longitudinal Real-Time Assessment and Evidence Analytics of Quality Indicators. Cancers (Basel) 2022; 15:cancers15010047. [PMID: 36612043 PMCID: PMC9817921 DOI: 10.3390/cancers15010047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Sarcomas represent a large group of rare to very rare diseases, requiring complex management with a transdisciplinary approach. Overall progress has been hampered because of discipline, institution and network fragmentation, and there is no global data harmonization or quality standards. To report on and improve quality, a common definition of quality indicators (QIs) of sarcoma care as well as the capacity to assess longitudinal real-time data is required. An international advisory board of world-renowned sarcoma experts defined six categories of QIs, totaling more than 80 quality indicators. An interoperable (web-based) digital platform was then created combining the management of the weekly sarcoma board meeting with the sarcoma registry and incorporating patient-reported outcome measures (PROMs) into the routine follow-up care to assess the entire care cycle of the patient. The QIs were then programmed into the digital platform for real-time analysis and visualization. The definition of standardized QIs covering all physician- (diagnostics and therapeutics), patient- (PROMS/PREMS), and cost-based aspects in combination with their real-time assessment over the entire sarcoma care cycle can be realized. Standardized QIs as well as their real-time assessment and data visualization are critical to improving the quality of sarcoma care. By enabling predictive modelling and introducing VBHC, precision health care for a complex disease is on the horizon.
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Affiliation(s)
- Philip Heesen
- Medical Faculty, University of Zurich, 8091 Zurich, Switzerland
| | - Gabriela Studer
- Faculty of Medicine, University of Lucerne, 6002 Lucerne, Switzerland
| | - Beata Bode
- Medical Faculty, University of Zurich, 8091 Zurich, Switzerland
| | | | | | - Paul Aliu
- Swiss Sarcoma Network, 6000 Luzern, Switzerland
| | | | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milano, Italy
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon-Bérard Lyon, 69008 Lyon, France
| | - Axel Le Cesne
- Department of Medical Oncology, Gustave Roussy Cancer Campus, 94805 Paris, France
| | - Bruno Fuchs
- Medical Faculty, University of Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Lucerne, 6002 Lucerne, Switzerland
- Correspondence:
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10
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Fayet Y, Chevreau C, Decanter G, Dalban C, Meeus P, Carrère S, Haddag-Miliani L, Le Loarer F, Causeret S, Orbach D, Kind M, Le Nail LR, Ferron G, Labrosse H, Chaigneau L, Bertucci F, Ruzic JC, Le Brun Ly V, Farsi F, Bompas E, Noal S, Vozy A, Ducoulombier A, Bonnet C, Chabaud S, Ducimetière F, Tlemsani C, Ropars M, Collard O, Michelin P, Gantzer J, Dubray-Longeras P, Rios M, Soibinet P, Le Cesne A, Duffaud F, Karanian M, Gouin F, Tétreau R, Honoré C, Coindre JM, Ray-Coquard I, Bonvalot S, Blay JY. No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks' Outcome? Cancers (Basel) 2022; 14:cancers14112620. [PMID: 35681600 PMCID: PMC9179906 DOI: 10.3390/cancers14112620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary As patients with rare cancers face specific problems, reference networks have been developed in several European countries and then at the European level to improve their management. In some cases, the specialized centers belonging to reference networks provide remote services (specialized diagnosis review, discussion in the Multidisciplinary Tumour Board, etc.) to increase access to these services. Using data from the national sarcoma reference network implemented in France (NETSARC+), the IGéAS research program assesses the potential of its organization to address the geographical inequalities in cancer management. We analyze the individual, clinical, and geographical determinants of the overall survival of sarcoma patients in France. We found no association between the overall survival of sarcoma patients and variables measuring their social deprivation, remoteness from reference centers, and geographical context. Following previous results from the research program, this study suggests that reference network organization should be considered to reduce cancer inequalities. Abstract The national reference network NETSARC+ provides remote access to specialized diagnosis and the Multidisciplinary Tumour Board (MTB) to improve the management and survival of sarcoma patients in France. The IGéAS research program aims to assess the potential of this innovative organization to address geographical inequalities in cancer management. Using the IGéAS cohort built from the nationwide NETSARC+ database, the individual, clinical, and geographical determinants of the 3-year overall survival of sarcoma patients in France were analyzed. The survival analysis was focused on patients diagnosed in 2013 (n = 2281) to ensure sufficient hindsight to collect patient follow-up. Our study included patients with bone (16.8%), soft-tissue (69%), and visceral (14.2%) sarcomas, with a median age of 61.8 years. The overall survival was not associated with geographical variables after adjustment for individual and clinical factors. The lower survival in precarious population districts [HR 1.23, 95% CI 1.02 to 1.48] in comparison to wealthy metropolitan areas (HR = 1) found in univariable analysis was due to the worst clinical presentation at diagnosis of patients. The place of residence had no impact on sarcoma patients’ survival, in the context of the national organization driven by the reference network. Following previous findings, this suggests the ability of this organization to go through geographical barriers usually impeding the optimal management of cancer patients.
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Affiliation(s)
- Yohan Fayet
- EMS Team–Human and Social Sciences Department, Centre Léon Bérard, 69008 Lyon, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
- Correspondence:
| | | | - Gauthier Decanter
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France;
| | - Cécile Dalban
- Department of Clinical Research and Innovation, Centre Léon Bérard, 69008 Lyon, France; (C.D.); (S.C.)
| | - Pierre Meeus
- Department of Surgery, Centre Léon Bérard, 69008 Lyon, France; (P.M.); (F.G.)
| | - Sébastien Carrère
- Institut de Recherche en Cancérologie Montpellier, INSERM U1194, 34000 Montpellier, France;
| | - Leila Haddag-Miliani
- Service D’imagerie Diagnostique, Institut Gustave Roussy, 94800 Villejuif, France;
| | - François Le Loarer
- Department of Pathology, Institut Bergonié, 33000 Bordeaux, France; (F.L.L.); (J.-M.C.)
| | | | - Daniel Orbach
- Centre Oncologie SIREDO (Soins, Innovation et Recherche en Oncologie de l’Enfant, de l’aDOlescents et de L’adulte Jeune), Institut Curie, Université de Recherche Paris Sciences et Lettres, 75005 Paris, France;
| | - Michelle Kind
- Radiologue, Département D’imagerie Médicale, Institut Bergonié, 33000 Bordeaux, France;
| | - Louis-Romée Le Nail
- Department of Orthopaedic Surgery, CHU de Tours, Faculté de Médecine, Université de Tours, 37000 Tours, France;
| | - Gwenaël Ferron
- INSERM CRCT19 ONCO-SARC (Sarcoma Oncogenesis), Institut Claudius Regaud-Institut Universitaire du Cancer, 31000 Toulouse, France;
| | - Hélène Labrosse
- CRLCC Léon Berard, Oncology Regional Network ONCO-AURA, 69008 Lyon, France; (H.L.); (F.F.)
| | - Loïc Chaigneau
- Department of Medical Oncology, CHRU Jean Minjoz, 25000 Besançon, France;
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France;
| | | | | | - Fadila Farsi
- CRLCC Léon Berard, Oncology Regional Network ONCO-AURA, 69008 Lyon, France; (H.L.); (F.F.)
| | | | - Sabine Noal
- UCP Sarcome, Centre François Baclesse, 14000 Caen, France;
| | - Aurore Vozy
- Department of Medical Oncology, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), CLIP(2) Galilée, Sorbonne University, 75013 Paris, France;
| | | | - Clément Bonnet
- Service d’Oncologie Médicale Hôpital Saint Louis, 75010 Paris, France;
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Centre Léon Bérard, 69008 Lyon, France; (C.D.); (S.C.)
| | | | - Camille Tlemsani
- Service d’Oncologie Médicale, Hôpital Cochin, Institut du Cancer Paris CARPEM, Université de Paris, APHP Centre, 75014 Paris, France;
- INSERM U1016-CNRS UMR8104, Institut Cochin, Institut du Cancer Paris CARPEM, Université de Paris, APHP Centre, 75014 Paris, France
| | - Mickaël Ropars
- Orthopaedic and Trauma Department, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France;
| | - Olivier Collard
- Département d’Oncologie Médicale, Hôpital Privé de la Loire, 42100 Saint-Etienne, France;
| | - Paul Michelin
- Service D’imagerie Médicale, CHU Hopitaux de Rouen-Hopital Charles Nicolle, 76000 Rouen, France;
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France;
| | | | - Maria Rios
- Department of Medical Oncology, Cancer Institute of Lorraine-Alexis Vautrin, 54500 Vandoeuvre Les Nancy, France;
| | - Pauline Soibinet
- Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, 51000 Reims, France;
| | - Axel Le Cesne
- Medical Oncology, Insitut Gustave Roussy, 94800 Villejuif, France;
| | - Florence Duffaud
- Department of Medical Oncology, CHU La Timone and Aix-Marseille Université (AMU), 13005 Marseille, France;
| | - Marie Karanian
- Department of Pathology, Lyon University Hospital, 69008 Lyon, France;
| | - François Gouin
- Department of Surgery, Centre Léon Bérard, 69008 Lyon, France; (P.M.); (F.G.)
| | - Raphaël Tétreau
- Medical Imaging Center, Institut du Cancer, 34000 Montpellier, France;
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy, Villejuif 94800, France;
| | - Jean-Michel Coindre
- Department of Pathology, Institut Bergonié, 33000 Bordeaux, France; (F.L.L.); (J.-M.C.)
| | | | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, 75005 Paris, France;
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon University, 69008 Lyon, France;
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Honoré C, Drovetti G, Geraud A, Epaillard N, Garcia GCTE, Colomba E, Matias M, Majer M, Ammari S, Khettab M, Hervé R, Mir O, Ducreux M, Gustin P. [Intercontinental Multidisciplinary Oncology Videoconferencing between the South Pacific and the French mainland: Results after one year and 323 cases of rare or complex cancers discussed]. Bull Cancer 2021; 108:1077-1084. [PMID: 34802717 DOI: 10.1016/j.bulcan.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Overseas France represents 18 % of French territory and is home to 4 % of its population for whom there is unequal treatment in the field of rare/complex cancer. AIM To report our experience of intercontinental multidisciplinary videoconferencing between the French mainland and Pacific territories. METHODS Every other friday, three centers located in Papeete, Nouméa and Paris-Villejuif connected between 6:30 AM and 8:00 AM GMT to discuss cases of rare/complex cancers. RESULTS Between November 2019 and December 2020, 323 presentations implicating 233 patients involved sarcoma (n=93), digestive pathology (n=60), neuroendocrine tumors (n=35), urology (n=24), gynecology (n=24), neurology (n=16), thyroid pathology (n=14), dermatology (n=14), senology (n=11), hematology (n=11), ENT pathology (n=10), pathology thoracic (n=10) and pediatrics (n=1). Of the 233 patients, 134 (57.5 %) living in New Caledonia and 99 (42.5 %) in French Polynesia, 117 (50.5 %) had metastatic disease. 39 patients (16.7 %) were transferred to French mainland (EVASAN), for surgery (n=25), vectorized radiotherapy (n=7), biopsy (n=5), chemotherapy (n=1) or inclusion in a clinical trial (n=1). 195 patients (83.7 %) were treated at home, 15 (6.4 %) are still awaiting a decision and 4 (1.7 %) lost to follow-up. CONCLUSION The use of videoconferencing to discuss rare/complex cancer cases was effective in guaranteeing French overseas population access to innovative therapies and clinical trials, limiting the need for intercontinental transfer to 16.7 %.
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Affiliation(s)
- Charles Honoré
- Gustave Roussy, Département d'Anesthésie Chirurgie et Interventionnel (DACI), département d'Anesthésie, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Gustave Roussy, service de chirurgie viscérale oncologique, 114, rue Edouard Vaillant, 94805 Villejuif, France.
| | - Gianmaria Drovetti
- Clinique Kuindo-Magnin, Département d'oncologie, 5, rue Contre-Amiral Joseph du Bouzet Nouville, 98800 Nouméa, Nouvelle-Calédonie, France
| | - Arthur Geraud
- Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France; Gustave Roussy, Département d'Innovation thérapeutique et d'essais précoces (DITEP), 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Nicolas Epaillard
- Centre Hospitalier de Polynésie Française, Département d'oncologie, avenue du Général de Gaulle, 98713 Pirae, Polynésie Française, France
| | - Gabriel C T E Garcia
- Gustave Roussy, Département de radiologie, 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Emeline Colomba
- Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Margarida Matias
- Clinique Kuindo-Magnin, Département d'oncologie, 5, rue Contre-Amiral Joseph du Bouzet Nouville, 98800 Nouméa, Nouvelle-Calédonie, France; Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Michael Majer
- Gustave Roussy, Département de radiologie, 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Samy Ammari
- Gustave Roussy, Département de radiologie, 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Mohamed Khettab
- Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France; CHU de La Réunion, service hématologie-oncologie, 97, avenue du Président Mitterrand, 97448 Saint-Pierre, La Réunion, France; Université de La Réunion, 15, avenue René Cassin, 97715 Sainte-Clotilde, La Réunion, France
| | - Robert Hervé
- Centre Hospitalier de Polynésie Française, Département d'oncologie, avenue du Général de Gaulle, 98713 Pirae, Polynésie Française, France
| | - Olivier Mir
- Gustave Roussy, département Interdisciplinaire d'organisation des Parcours Patients (DIOPP), 114, rue Edouard Vaillant, 94805 Villejuif, France
| | - Michel Ducreux
- Gustave Roussy, Département de médicine oncologique (DMO), 114, rue Edouard Vaillant, 94805 Villejuif, France; Université Paris-Saclay, 3, rue Joliot Curie, 91190 Gif-sur-Yvette, France
| | - Pierre Gustin
- Centre Hospitalier de Polynésie Française, Département de Radiothérapie, avenue du Général de Gaulle, 98713 Pirae, Polynésie Française, France
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12
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Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer R, Abudu A. Impact of the national sarcoma guidelines on the prevalence and outcome of inadvertent excisions of soft tissue sarcomas: An observational study from a UK tertiary referral centre. Eur J Surg Oncol 2021; 48:533-540. [PMID: 34838395 DOI: 10.1016/j.ejso.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This study aims to investigate the impact of the national guideline on the prevalence and outcome in patients with soft-tissue sarcoma (STS) who had undergone inadvertent excisions. METHODS A total of 2336 patients were referred to a tertiary sarcoma centre from six regions (North East, North West, East Midlands, West Midlands, Wales, and South West) in the United Kingdom with a diagnosis of STS between 1996 and 2016, of whom 561 patients (24.0%) had undergone inadvertent excisions. Patients were categorised into two groups of 10-year periods pre and post the National Institute for Health and Clinical Excellence (NICE) guideline implementation in 2006. RESULTS The proportion of inadvertent excisions decreased after the NICE guideline implementation: 27.2% (pre-NICE) versus 19.8% (post-NICE) (p = 0.001). A substantial regional variation (17.4%-34.5%) in the proportion of inadvertent excisions in the pre-NICE era was reduced in the post-NICE era (14.3%-22.4%). The 5-year disease-specific survival was 77.7% (pre-NICE) versus 75.6% (post-NICE) (p = 0.961) and there was a trend toward lower incidence of local recurrence in the post-NICE era; 13.5% (pre-NICE) versus 10.5% (post-NICE) (p = 0.522). Multivariate analyses revealed that residual tumours in re-resection specimens were independently associated with an increased risk of disease-specific mortality (HR, 3.35; p < 0.001) and local recurrence (HR, 1.99; p = 0.017), which was significantly reduced after the NICE guideline implementation (53.2% versus 42.0%; p = 0.022). CONCLUSIONS The NICE guideline implementation reduced the proportion of patients with STS who had undergone inadvertent excisions and residual tumour in re-resection specimens, indicating an improved pre-referral management of STSs.
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Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Scott Evans
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Grimer
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adesegun Abudu
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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13
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Lavit E, Aldea M, Piperno-Neumann S, Firmin N, Italiano A, Isambert N, Kurtz JE, Delcambre C, Lebrun V, Soibinet-Oudot P, Chevreau C, Bompas E, Le Maignan C, Boudou-Rouquette P, Le Cesne A, Mancini J, Blay JY, Duffaud F. Treatment of 120 adult osteosarcoma patients with metachronous and synchronous metastases: A retrospective series of the French Sarcoma Group. Int J Cancer 2021; 150:645-653. [PMID: 34562271 DOI: 10.1002/ijc.33823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
Treatment options for metastatic osteosarcomas are scarce. Following failure of standard first line therapy, patients who relapse present a challenging treatment dilemma, and have a poor prognosis. Surgical removal of all metastases is essential. A retrospective analysis of patients with metastatic osteosarcomas was conducted in 15 French Sarcoma Group centers. From January 2009 to December 2018, we identified 120 adult patients; 36 with synchronous and 84 with metachronous metastases with 74 males and 46 females. Mean age was 30 years (18-53). Metastatic sites were lung, bone and other in 91, 11 and 24 patients, respectively. Mean time to first metachronous metastases was 22 months (4-97). All patients except 13 (10.8%) with metachronous metastases received a first line systemic treatment for relapse, and 39 patients (32.5%) were included in a clinical trial. Eighty-one patients (67.5%) had local treatment of distant metastases. Median progression free survival (PFS) and overall survival (OS) were 5.5 (95% CI 4.6-6.4) and 20.5 months (95% CI 13.2-27.7) respectively for the overall group. In multivariate analysis, more than five metastases, time to first metastases <24 months, were statistically significant negative prognostic factors for OS and PFS (P = .002, ≤.001 and P = .006, ≤.001, respectively). Surgery of metastases was associated with better prognosis on OS and PFS (P = .001 and .037, respectively). The presence of bone metastases was a negative prognostic factor on OS but not on PFS (P = .021). In reference sarcoma centers, relapsed osteosarcoma patients with more than one metastasis commonly receive more than one line of systemic therapy, and are included in clinical trial if available.
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Affiliation(s)
- Elise Lavit
- Department of Oncology, Hôpital La Timone, Marseille, France
| | | | | | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Jean-Emmanuel Kurtz
- Department of Onco-Hematology, University Hospital Strasbourg, Strasbourg, France
| | | | - Valérie Lebrun
- Department of Oncology, University Hospital Dupuytren, Limoges, France
| | | | | | | | | | | | | | - Julien Mancini
- Department of Oncology, Hôpital La Timone, Marseille, France.,Aix Marseille University, Inserm, IRD, SESSTIM, Marseille, France
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