
<b>When dealing with HMOs or medical insurance companies or government institutions [VA hospitals, Army, Navy, Air Force] you may need ammunition for justification to get sarcoma oncologist treatment at a major sarcoma center.
Go to the original online sources listed below and print them out.  Using the printout to justify your intended treatment is a perfectly acceptable use of copyright material.  You will not get into trouble.</b>

These articles recommend the use of sarcoma oncologists and sarcoma teams at sarcoma centers to manage sarcomas, because  patient survival is so much better.


1. The October, 2000 issue of the Lancet Oncology Journal states, "When diagnosed and managed in a non-specialist environment, outcome is generally significantly poorer than if patients are managed by a multidisciplinary team in a tertiary centre of excellence. Prompt referral of patients with clinically suspicious masses is strongly advocated, before any type of intervention is attempted."
The full article is at the &&url. Complete the free registration, then search for <b>Singer, Demetri, et.al., "Management of Soft Tissue Sarcomas: an Overview and Update", Lancet Oncology, October 2000.</b>
[You may have to order the full text from your local librarian.]

 
2. Further justification for using a sarcoma oncologist and a sarcoma team at a sarcoma center to manage sarcomas is given by the NCCN guidelines. These two references, the Lancet Oncology article and the NCCN guidelines are useful when petitioning insurance companies or HMO's for reimbursement for sarcoma oncologist referrals.

The NCCN guidelines repeatedly state:  <b>"All patients should be managed by a multidisciplinary team with expertise in sarcoma."</b>

NCCN Guidelines for Soft Tissue Sarcomas and for Uterine Sarcomas can be obtained from the NCCN, or downloaded from their site.  &&url Choose the Health Professional versions, always.


<b>National Comprehensive Cancer Network
50 Huntingdon Pike, Suite 200    Rockledge, PA 19046    Phone: 215-728-4788    Fax:  215-728-5641 ; 215-728-3877
http://www.nccn.org
You have to state they are for your own use and for information purposes only. They are free.  You do not have to be a doctor.</b>

Use of NCCN guidelines to convince someone at your HMO or medical insurance agency of the necessity of sarcoma oncologists is a perfectly valid use of them. These are GUIDELINES. For guidelines to function, they have to be disseminated.

 
 3.  <b>Eur J Cancer 1996 Feb;32A(2):269-73
The importance of a multidisciplinary group in the treatment of soft tissue sarcomas. </b>Wiklund T, Huuhtanen R, Blomqvist C, Tukiainen E, Virolainen M, Virkkunen P, Asko-Seljavaara S, Bjorkenheim JM, Elomaa I. 
Department of Radiotherapy and Oncology, Helsinki University Hospital, Finland. 

"In 1987, a multidisciplinary soft tissue sarcoma (STS) group was established and a treatment protocol was set up. By 1993, there were 193 patients with a diagnosis of STS of the superficial trunk or extremities. ...."
"The estimated 3-year survival, local control and disease-free survival rates are 79, 87 and 69%, respectively. These results compare favourably with previously published results from this hospital and from a nationwide study. <b>The improved results emphasise the importance of a multidisciplinary STS group." </b>
&&url PMID: 8664040 


4.  <b>2002 CTOS Annual Meeting Oral Presentations - Surgery  
Copyright © 2003  Connective Tissue Oncology Society

SHOULD SOFT TISSUE SARCOMAS BE TREATED AT A SPECIALIST CENTRE?</b> [Abstract ID: 48] 
Robert Grimer, Aneel Bhangu, John Beard; Royal Orthopaedic Hospital, United Kingdom   rob.grimer@btopenwold.com 

"Study Question:  Whether patients with soft tissue sarcomas do better if treated in a specialist center compared with district general hospitals."

"All soft tissue sarcoma patients' outcomes were analyzed in a geographical health region in the UK for three years, with at least a 5 year followup period.  Appropriateness of treatment, adequacy of surgery, and outcomes in terms of local control and overall survival were investigated.  Results are stratified for known risk factors for local control and survival (grade, depth and size)."

"260 patients were diagnosed as having STS over the 3 year period of whom 37% had the majority of treatment at the specialist centre under the care of 2 surgeons, whilst the other 63% were treated at a total of 38 different hospitals. Local recurrence rates were 20% at the specialist centre and 37% at the general hospitals. Overall survival was 58% at five years and was related to grade, depth and size of tumour. Patients treated at the specialist centre had larger tumours (10.3 vs 7.3cm) with a higher proportion of deep and high grade tumours. Overall survival at the two centres was identical but when stratified for known risk factors the survival rate was 1.6 times better at the specialist centre, this difference  being especially obvious for Stage III tumours (p = 0.009). "

<b>"Conclusions: Soft tissue sarcomas are rare. Centralization of treatment, especially for high grade tumours improves survival,  local control and patients' care." </b>
&&url


5. <b>Ned Tijdschr Geneeskd 1995 Apr 22;139(16):833-7 
[Consensus soft tissue tumors. Dutch Workgroup Soft-Tissue Tumors]. [Article in Dutch] </b>
Van Geel AN, Van Unnik JA, Keus RB. Dr. Daniel den Hoed Kliniek, afd. Chirurgische Oncologie, Rotterdam. 

"Soft-tissue sarcomas constitute a rare group of malignant tumours with histopathological features of connective, muscular, fatty or peripheral nervous tissue. <b>The prognosis at manifestation depends on only two factors: the spread, both local and remote, and the biological behaviour of the tumour. The latter factor cannot be influenced but the former can: by inexpert manipulation. Consequently, tumours suspected of being soft-tissue sarcomas require multidisciplinary management from the beginning, with the team members familiar with each other's diagnostic and therapeutic skills.</b> Imaging diagnostic methods should precede invasive methods for collection of material for pathological examination. The number of mitotic figures observed at microscopical examination of the tissue is an important prognostic feature. Surgical resection is the treatment of first choice. Radiotherapy is indicated in grade 3 tumours, after recurrence surgery, and when radical resection would involve too much mutilation. Chemotherapy is only given in the context of clinical trials. Surgical treatment of lung metastases may be indicated in selected patients. Regional isolated perfusion with tumour necrosis factor may be an alternative for limb amputation.  Publication Types: Consensus development conference Review "
&&url PMID: 7731476 

6.  <b>Sarcoma, Vol 7, Nos. 3-4/September-December 2003 pp159 - 165  

Factors influencing prognosis after initial inadequate excision (IIE) for soft tissue sarcoma</b>

Albert N. Van Geel, Alexander M.M. Eggermont, Patrick E.J. Hanssens, Paul I.M. Schmitz 
University Hospital Rotterdam/Daniel den Hoed Cancer Center Rotterdam The Netherlands

"The influence of initial inadequate excision (IIE) of soft tissue sarcoma (STS) on local control and overall survival is not well established. ...."

"Specimens of the subsequent radical resection showed residual tumor in 66 patients (77%).  In ... analyses, grade II/III tumors and complications after IIE are significant negative prognostic factors for local recurrence-free survival (P = 0.008 and P = 0.002, respectively, in the Cox model). ... Adjuvant radiotherapy did not change the rate of local recurrence-free survival.  For overall survival, only tumor grade is a significant factor (log-rank test)."

<b>"... For better diagnosis and therapy STS should be treated in specialized centers."</b>
&&url


written by doctordee, last updated January 2004