Commentary It is the dreaded news that we as oncology providers occasionally need to deliver to patients: “You have cancer.” Where should they turn for the best care? Is a local hospital enough, or is it beneficial to travel a farther distance to receive care at a more specialized institution? If that cancer happens to be a bone sarcoma, Fujiwara et al. have done a commendable job in providing further insight into this question in their current article. In recent years, an increasing amount of literature has been published with regard to improved outcomes at high-volume centers for many types of cancer, including non-orthopaedic tumors such as colorectal cancer1. As it relates to musculoskeletal malignancies, Abarca et al.2 showed, for extremity soft-tissue sarcomas, and Schmitz et al.3 showed, for retroperitoneal soft-tissue sarcomas, that high-volume facilities had a better overall survival rate and a lower rate of positive surgical margins when compared with lower-volume centers. Intuitively, I think, for those of us who treat bone sarcomas, it is understood that you need a multidisciplinary team in place with an abundance of experience and adherence to nationally accepted treatment guidelines. From a surgical standpoint, improved outcomes seem to correlate with repetition of treatment. However, what may not seem intuitive is that, when it comes to a rare type of tumor such as a bone sarcoma (only roughly 3,900 new cases will be diagnosed in the United States this year), the critical volume of experience needed to optimize outcomes is likely not available at every institution and may not even be available within every state. Given the limitation in new cases each year, centralized care for patients with bone sarcoma, or any other unique cancer, seems like an enticing system to help to improve survival. If a patient lives close to a high-volume center, then this treatment route is a no-brainer. However, for patients who may live farther away, choosing to travel a long distance to receive care at a high-volume center may mean lengthy time away from family and other support systems. If these individuals choose to not travel to a high-volume center, does this necessarily mean that they are negatively impacting their ability to be alive 5 years or even 10 years from now? I am not sure that we have a fully transparent answer to that question yet. As shown in the current article and previously reported by Malik et al.4, the overall survival for adult patients with bone sarcoma was not necessarily impacted by how far they had to travel to receive care but rather seeking care at an institution with extensive experience in treating this malignancy. In the virtual world in which we now live and with the increase in community-based hospital partnerships with high-volume National Cancer Institute (NCI) institutions, a patient now expects to receive the same level of expert care closer to home. What would be interesting to know (and is certainly beyond the scope of this article) is whether improved survival holds up at lower-volume centers that partner with higher-volume centers and adhere to nationally accepted treatment guidelines. I think that the landscape of musculoskeletal oncology would look quite different if we were to move toward a more centralized care pattern for patients with bone sarcoma. In his commentary article discussing high-volume centers compared with low-volume centers as they relate to pancreatic cancer, Carr5 brought up many relevant points that I think merit consideration for bone sarcomas. As Carr stated, it is simply not practical for patients with cancer, even rare or unique cancers, to be treated at only a handful of high-volume institutions. In addition, those patients who have complex reconstructive surgical procedures at places far away from where they live may require follow-up or operative care locally for complications that arise. A patient may travel once for a surgical procedure, but that willingness may wane over time for follow-up visits, leaving the onus on more local, less-experienced institutions to complete their course of care. Another point to consider is the need for increased oncology specialists at these high-volume centers to meet the potential increase in patient demand. In the end, we all want the best care for the patients whom we treat. The reality is that not every patient will travel, despite what the data show. The challenge then becomes how we can disseminate knowledge and experience to help to level the playing field so that adult patients can receive top-notch care for bone sarcoma closer to home. I am hopeful that future studies will help in clarifying this.