Integrated Care in Specialized Networks: Leveraging Early Referrals to Reduce Local Recurrence in Soft Tissue Sarcoma
by
, ,
on behalf of the Swiss Sarcoma Network
Markus Schärer
1, 
Pascale Hösli
2,
Philip Heesen
2
,
Georg Schelling
3,4,
Timothy Obergfell
2,
Kim N. Nydegger
4,
Gabriela Studer
3,4,
Beata Bode-Lesniewska
2 and
Bruno Fuchs
1,3,4,*,†
on behalf of the Swiss Sarcoma Network 1
Sarcoma Service, Klinik für Orthopädie und Traumatologie, Sarcoma Center, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
2
Medical Faculty, University of Zurich, 8032 Zurich, Switzerland
3
Faculty of Health Sciences & Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland
4
Sarcoma Service, Department of Orthopedics and Trauma, Sarcoma Center, LUKS University Hospital, 6000 Lucerne, Switzerland
*
Author to whom correspondence should be addressed.
†
Additional Collaborators of the Swiss Sarcoma Network are indicated in the Acknowledgement.
Cancers 2024, 16(21), 3616; https://doi.org/10.3390/cancers16213616
Submission received: 22 September 2024
/
Revised: 16 October 2024
/
Accepted: 24 October 2024
/
Published: 26 October 2024
(This article belongs to the Special Issue Outcome Analysis and Predictive Insights in Soft Tissue Sarcomas: leveraging Clinical Data and Integrating Modelling)
Simple Summary
This study examines how care pathways impact local recurrence (LR) rates in patients with soft tissue sarcomas (STS). It compares outcomes between those managed entirely within a comprehensive care pathway (CCP) at the Swiss Sarcoma Network (SSN) and those with a fragmented care pathway (FCP) where initial treatment occurred outside specialized centers. Patients in FCPs had higher LR rates, unplanned “whoops” resections, and positive surgical margins, highlighting the critical role of referral patterns and early, coordinated care. The findings underscore the need for better education and standardized early referrals to improve outcomes and establish quality benchmarks in specialized sarcoma care.
Abstract
This study evaluated the impact of care pathways on the incidence of local recurrence (LR) in patients with soft tissue sarcomas (STS) and identified factors predictive of LR. It compared outcomes between patients managed entirely within a comprehensive care pathway (CCP) at the Swiss Sarcoma Network (SSN) and those who experienced fragmented care pathways (FCPs), where initial treatment occurred outside specialized centers. This prospective study utilized real-world-time data from the SSN-Sarconnector, capturing quality indicators through weekly Multidisciplinary Team/Sarcoma-Board (MDT/SB) meetings. The overall incidence of LR was 17.6% (n = 68/386), higher than rates typically reported in sarcoma center-based studies due to the inclusion of patients with prior inadequate management from real-world referrals. In a univariable logistic regression analysis, the FCP was significantly associated with higher LR rates, unplanned “whoops” resections (25.4%, n = 96), and positive surgical margins, emphasizing the detrimental impact of suboptimal initial management outside of specialized centers. Multivariable analysis confirmed that the FCP (aOR 2.7, 95% CI [1.41, 5.12], p = 0.003), tumor size (aOR 1.49, 95% CI [1.1, 2.02], p = 0.01), and biological behavior (aOR 5.84 95% CI [1.8, 18.86], p = 0.0003) are independent predictors of LR. Notably, patients referred to sarcoma centers after an initial FCP presented with inadequately managed disease, such as incomplete resections and unplanned surgeries, leading to increased complexity of subsequent treatments. These findings underscore the critical role of referral patterns on sarcoma center outcomes, highlighting the significant disparity in LR rates between institutions. The need for improved education and standardized early referral strategies at the spoke level is paramount to optimize patient outcomes and reduce the burden of LR. Enhanced spoke-level education and standardized referral protocols are critical to ensuring effective initial management and optimizing patient outcomes within specialized sarcoma networks like the SSN.
