VARIABLE MANAGEMENT OF SOFT-TISSUE SARCOMA - REGIONAL AUDIT WITH IMPLICATIONS FOR SPECIALIST CARE

Background The aim of this study was to determine how and by which spe cialties patients with soft tissue sarcoma are Investigated and treate d within a single large health region and with what outcomes and impli cations for resource uptake. Methods By retrieving the records of 377 patients with primary soft tissue sarcoma treated in the South-East Th ames Region between 1986 and 1992 the presentation, investigation: tre atment and outcome were compared with defined criteria for optimal man agement. Patient management was assessed and compared between specialt ies and districts on the basis of outpatient time, appropriate use of radiological investigations and preoperative biopsy, type of surgery, content of the pathology report and the incidence of local recurrence, metastasis and death over a mean follow-up period uf 2.5 years. Resul ts Most patients (53.6 pet-cent) were treated by general surgeons, irr espective of tumour location. Overall only 21.3 per cent of patients w ere investigated optimally with wide variation among specialties, Only 60.0 per cent were treated adequately (wide excision or surgery with radiotherapy). Uptake of adjunctive therapy and follow-up were variabl e. Outcome was poorer in patients having a marginal excision and recur rence. Conclusion Investigation and management of many patients with s oft tissue sarcoma was both variable and suboptimal. This has implicat ions for patient care, resource uptake and costs. As has been amply de monstrated elsewhere, patients with sarcoma are more appropriately man aged in specialist centres.