Soft tissue sarcoma - Compliance with guidelines

BACKGROUND. Because soft tissue sarcomas (STS) are rare, guidelines for the diagnosis and treatment of patients with STS were developed. Because the d iagnostic management is essential for definitive treatment, adherence to th ese guidelines is important. METHODS. Primary STS registered by the Comprehensive Cancer Center North-Ne therlands from January 1989 to January 1996 were analyzed retrospectively w ith regard to adherence to the diagnostic guidelines. Urogenital, gastroint estinal STS, and Kaposi sarcomas were excluded. RESULTS. Three hundred fifty-one STS patients were analyzed. In the special ized center, 69% of patients were age < 60 years, whereas, in district hosp itals, 63% of patients were age > 60 years. With increased age, referral to the center declined in a linear fashion. For all guidelines, adherence was significantly better in the center. In district hospitals, patient volume had no significant influence on compliance with the guidelines, except for the management of patients with STS greater than or equal to 3 cm. In distr ict hospitals, where fewer than 15 patients were treated in the 7-year peri od, significantly more often, an inadequate biopsy or even no biopsy proced ure was performed prior to resection. CONCLUSIONS. In many aspects of the diagnostic process of STS, existing gui delines were not followed, especially in community hospitals. Adherence to all individual guidelines was significantly better in the specialized cente r. To improve compliance with future STS guidelines, appropriate guideline development, dissemination, and implementation programs should be developed . Concentration of patients with STS in a limited number of hospitals and i ntensified collaboration with specialized centers seem advisable. Special a ttention should be paid to older patients, who significantly more often wer e not referred to a specialized center. Cancer 2001;91:2186-95. (C) 2001 Am erican Cancer Society.