Results of Clinical Audit on the Quality of Sarcoma Management Support Centralisation of Rare Cancer Care in Catalonia (Spain)

Abstract

ABSTRACT Aim: Sarcomas are a low frequency tumour. The range of their histological types and differences in anatomical site account for the difficulty in their diagnosis and treatment. Our aim was to assess the quality of cancer care in soft tissue sarcoma (STS) and in bone sarcoma (BS) through the adherence to Clinical Practice Guidelines, the analysis of survival in public hospitals of Catalonia during a three years period. Methods: Multicenter retrospective cohort study of patients with STS and BS diagnosed at Catalonian public hospitals from 2006 to 2008. Using the Catalonian Hospital Discharge database and the histological diagnosis of the hospital pathology units, we identified all patients who were discharged over the study period. Pathology reports and clinical records were reviewed and data on diagnosis, management and follow-up were collected. The statistical analysis included: descriptive analysis, stratification by hospital volume, and multivariate logistic regression analysis. Results: The study included 557 patients with STS and 121 with BS from 46 hospitals. Of the STS cases, 56.2% were men and tumor was located in the extremities in 45.8%. Histological grade was high in 50.8% while 86% of STS patients underwent surgery (±adjuvant treatment). Of BS cases, 58.7% were men and tumor was located in the extremities in 51.2% while 83. 5% underwent surgery (±adjuvant treatment). Compared to high-caseload hospitals (>90 cases in 3 years), those with a low-caseload registered significantly lower proportion of multidisciplinary team meeting assessment and surgery with adjuvant therapy and higher rates of non planned surgery and reintervention of STS patients. Also low caseload hospitals registered a significantly lower overall survival of STS patients (p=0.037). Similar results were found among BS, without statistic significance, due to the sample size. Conclusions: Treatment of patients with STS in referral centers with high-volume of cases appears to be associated with better quality of care and outcomes. These results support a model of care based on the centralisation of rare cancer care in a limited number of reference centres as have been recently implemented in our region. Disclosure: All authors have declared no conflicts of interest.