Abstract

Using a national survey of sarcoma experts with an exceptionally high response rate, Wasif and colleagues1 present an interesting study designed to evaluate whether physician specialty influences adjuvant treatment recommendations in the multidisciplinarymanagement of soft tissue sarcomaand the perceived benefit of thesemodalities. They reveal a specialty bias in treatment recommendations for soft tissue sarcomaof theextremities thatprovidesunique insights intounderstanding theexistingvariation in treatment approaches for this relatively rare disease. This study1 raises some important issues regarding thecurrent treatment of soft tissue sarcomaand the factors influencing recommendations for adjuvant therapy. Not surprisingly, Wasif and colleagues1 identified physician specialty–associatedvariation inadjuvant treatment recommendations for many clinical scenarios involving soft tissue sarcomaof the extremities. These findings suggest that the quality of available evidence may be insufficient to standardize clinical decision making and, importantly, that physician specialtymay play a prominent role in treatment decisions. This may be based on training paradigms (ie, better knowledge of the literature in one’s own domain), or it may also be self-serving (eg, physician reimbursement may prompt utilization of their services).Nonetheless, thecoordinatingphysician’s specialtymay have the greatest effect on the treatment plan and use of adjuvant therapies by controlling subsequent referrals. Given its rarityandhistologicheterogeneity, soft tissuesarcoma presents several unique challenges in patient management. To address this challenges, the National Comprehensive Cancer Network has compiled comprehensive patient treatment guidelines that are universally available and updatedannuallybyamultidisciplinaryspecialistpanel fromeach member institution.2 Although the majority of evidence on which theguidelines arebased is level 2A (basedon lower level evidence) for the vast majority of recommended interventions, there is consensusamong themultispecialtypanels.Additional histology-specific studies on the role and sequenceof adjuvant treatment may guide treatment for specific histologic subtypes. In the end, we concur with Wasif and colleagues1 andwith theNationalComprehensiveCancerNetwork sarcoma panel: All sarcoma patients should be managedby amultidisciplinary teamwith expertise in sarcoma to mitigate individual physician and physician specialty treatment bias.

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