Why Multi-disciplinary Care is Important in Sarcomas
The National Cancer Control Network (NCCN) in the US and the National Institute for Health and Clinical Excellence (NICE) have issued detailed recommendations for the management of patients with sarcoma. These are accessible at www.nccn.org and www.nice.org.uk respectively.
A critical component of these recommendations is that all patients with sarcoma should be treated at centres with appropriate expertise and relevant multidisciplinary teams (MDT). The evidence for these recommendations is available from NICE (http://www.nice.org.uk/nicemedia/pdf/SarcomaFullGuidance.pdf). As these recommendations are based on the different populations and health care systems in the US and UK, the Australasian Sarcoma Study Group has slightly modified these for the Australian setting.
There is sound evidence to support the following conclusions1:
- Radiology: That specialist review of the imaging in people with suspected sarcoma reduces clinical error rates and delay in diagnosis (p 43).
- Pathology: That the histopathological diagnosis of sarcoma is often changed on review by an expert pathologist; this includes the diagnosis of sarcoma, sarcoma sub-type and tumour grade (p 50).
- MDT: That being treated at a sarcoma MDT centre results in better overall survival, increased disease-free survival, reduced risk of amputation, better conformity to clinical practise guidelines and greater use of preoperative imaging and biopsy (p 58-59 ).
- Supportive care: That coordinated supportive care is associated with improved patient quality of life, fewer days in hospital, fewer home visits required and better physical, social and emotional outcomes (p 82).
- Participation in clinical trials correlates with survival rates for patients with sarcoma (Bleyer et al.2).
Please note that the recommendations for centralisation of care for paediatric sarcomas (osteosarcoma, Ewing sarcoma/Primitive neuroectodermal tumor, rhabdomyosarcoma) is particularly important, owing to: the rarity of these cancers; the lack of a large evidence base for treatment; the complexity and intensity of the treatment regimens; and the high mortality from these cancer types. As a consequence, the ASSG strongly recommends that all patients with paediatric sarcomas under the age of 16 years be treated at a paediatric cancer centre, and that older patients be treated at a specialist sarcoma centre. For other sarcoma types, the recommendation is that a specialist sarcoma multidisciplinary team assesses patients even if subsequent treatment is carried out elsewhere.
Modified key recommendations are based on the National Institute for Health and Clinical Excellence Guidance on Cancer Services3
- All patients with a confirmed diagnosis of bone or soft tissue sarcoma (except children with certain soft tissue sarcomas) should have their care supervised by or in conjunction with, a sarcoma multidisciplinary team.
- A soft tissue sarcoma MDT should meet minimum criteria for caseload. In the UK this is specified as at least 100 new patients with soft tissue sarcoma per year, or at least 25 new patients with bone sarcoma per year (p 54). Given the difference in population and the size of the landscape, these figures must me modified for the Australian setting.
- The sarcoma MDT should include
- A specialist sarcoma pathologist and/or radiologist who is able to review each patient’s pathology and radiology
- A surgeon who is a member of a sarcoma MDT or a surgeon with tumour site-specific or age-appropriate skills, in consultation with the sarcoma MDT
- Medical and radiation oncology expertise. Chemotherapy and radiotherapy should be carried out by appropriate specialists as recommended by a sarcoma MDT
- Dedicated ancillary supportive care, which includes nursing, physio- and occupational therapy, age-appropriate psychosocial support and palliative care
- Access to relevant clinical trials.
- All sarcoma MDTs should participate in national audit, data collection and training.
- Patients with functional disabilities as a consequence of their sarcoma should have timely access to appropriate support and rehabilitation services.
1National Institute for Health and Clinical Excellence, 2006. Improving outcomes for people with sarcoma. NICE guidance on cancer services.
2Bleyer, A., Montello, M., Budd, T., and Saxman, S. 2005. National survival trends of young adults with sarcoma: lack of progress is associated with lack of clinical trial participation. Cancer 103:1891-1897
3National Institute for Health and Clinical Excellence, 2006. Improving outcomes for people with sarcoma. NICE guidance on cancer services.
Last update: 22-Jul-2011 05:30 PM