Soft tissue sarcomas: Disease burden and health system response in Peru.

Abstract

e23557 Background: The management of soft tissue sarcomas (STS) presents a challenge in Peru, with a fragmented health system and few centers specialized in sarcoma care. There is no national cancer registry, which does not allow us to have a real view of the most prevalent types. Our aim was to determine the incidence in Instituto Nacional de Enfermedades Neoplásicas (INEN) and to know the real care capacity of cancer centers nationwide. Methods: A retrospective study was carried out in INEN between 2009 and 2015 to know the incidence of STS. Also, a survey was carried out to determine the real capacity of diagnosis and treatment care of cancer centers located in different regions of our country. Results: We were able to determine the anatomopathological diagnosis in 1804 (100%) patients. 52,1% were male (n = 899). Median age was 43 years (15-96). The most frequent sarcoma was undifferentiated pleomorphic sarcoma with 482 patients(27.9%), followed by liposarcoma in 269 (15,6%) and leiomyosarcoma in 159 (9%). The most common primary location was the limbs with 892 patients (51.7%), followed by the abdomen and pelvis with 423 (24.5%), and the least common was the head and neck with 207 patients (12%), followed immediately by the thorax with 205 patients (11.9%). According to the region of origin, 551 (31.9%) patients came from the northern region, 175 (10.1%) from the south, 35 (2%) from the east, 308 (17.8%) from the central region, and 658 (38.1%) from Lima and Callao. We obtained responses from 20 oncology centers of the Ministry of Health along 12 regions operating nationwide. Eight (40%) oncology centers are located in Lima and twelve (60%) in the rest of Peru. 100% (n = 20) of centers have medical oncologists, 70% (n = 14) have surgical oncologists, 65% (n = 13) have traumatologist and pathologist. About capacity of resolution: 100% (n = 20) perform direct biopsy of soft tissue tumors and 60% (n = 12) perform image-guided biopsies; regarding pathology, 95% (n = 19) performed morphological approach and 45% (n = 9) immunohistochemistry studies. 100% (n = 20) can perform ultrasound studies, 95% (n = 19) tomography, and 35% (n = 7) magnetic resonance imaging. 90% (n = 17) accomplish radical surgeries and 60% (n = 12) limb sparing surgeries. 85% (n = 17) enforce chemotherapy treatment. Only 50% (n = 10) have a radiotherapy service. 25% (n = 5) hold multidisciplinary meetings continuously while 40% (n = 8) hold them occasionally for complex cases. Only 8 oncology centers (out of a total of 20) have all the services to care for the complexity of a patient with soft tissue sarcoma, the majority (n = 3) located in Lima. Conclusions: Nearly 1,800 patients have been diagnosed in this reference institution in a period of 5 years, however it represents an underestimation of the real incidence. Cancer centers that can provide complete care for patients with soft tissue sarcomas are scarce, creating a gap in care for this pathology.