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 specialties patients with soft tissue sarcoma are investigated and treated within a single large health region and with what outcomes and implications for resource uptake. METHODS: By retrieving the records of 377 patients with primary soft tissue sarcoma treated in the South-East Thames Region between 1986 and 1992, the presentation, investigation, treatment and outcome were compared with defined criteria for optimal management. Patient management was assessed and compared between specialties 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 of 2.5 years. RESULTS: Most patients (53.6 per cent) were treated by general surgeons, irrespective of tumour location. Overall only 21.3 per cent of patients were 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 variable. Outcome was poorer in patients having a marginal excision and recurrence. CONCLUSION: Investigation and management of many patients with soft tissue sarcoma was both variable and suboptimal. This has implications for patient care, resource uptake and costs. As has been amply demonstrated elsewhere, patients with sarcoma are more appropriately managed in specialist centres.