From: "Dr. D. Kossove" <doctordee@telkomsa.net>
To: "David Murphy" <murfyda@pacbell.net>
Subject: management of lumps
Date: Tuesday, January 06, 2004 2:52 PM

Date:    Mon, 5 Jan 2004 22:25:28 -0800
From:    Dave Murphy <murfyda@PACBELL.NET>
Subject: The Scandinavian Model - As good as it gets?

There has been a discussion on the SARCOMA list about lumps, and how WE can
educate doctors about referrals to specialist centers when a lump is found.
This is a response I wrote to the sarcoma list that I thought I would share with
the LMS list.

Dave Murphy

-----Original Message-----
From: Dave Murphy [mailto:murfyda@pacbell.net]
Sent: Monday, January 05, 2004 10:06 PM
To: Sarcoma Listserv
Subject: The Scandinavian Model - As good as it gets?


At the last CTOS (Connective Tissue Oncology Society http://www.ctos.org)
conference in Nov 2003 there were several presentations on the diagnosis of
sarcomas, "When is a lump a Sarcoma? - An analysis of 1100 lumps", "An Analysis
of the Significance of Pain as a Symptom of Extremity Soft Tissue Sarcomas",
"Compliance with National Guidelines for the Diagnosis and Treatment of Soft
Tissue Sarcomas in Clinical Practice", and "Referral Patterns for Patients with
Sarcoma in the Northern & Yorkshire NHS region, Where to Target the Message?".
This was followed by a presentation by the Scandinavian Sarcoma Group's "The
Scandinavian Model - As Good as it Gets?".  CTOS usually posts the abstracts of
the presentations a few months after the conference, but they are not yet
posted.

The Scandinavian Sarcoma Group's presentation talked about "imposing" guidelines
on the treatment of lumps beginning 20 years ago.  I'll tell you what I have
from my notes, but hopefully the posted abstracts will have more complete
information.  They stated that before a doctor can treat a sarcoma, they must
first learn to recognize them.  At that time (20 years ago) they found that for
every 200 benign lumps, they found one malignant lump.  So they stated in the
new guidelines (20 years ago) that for every superficial lump greater than 5cm,
and for EVERY deep lump, the patient should be referred to a specialist center.
They decided to concentrate on medical students.  The Scandinavian Sarcoma Group
gave lectures at hospitals, and at medical schools, and they sent positive
letters to surgeons that complied with the new guidelines (this seemed to work
the best).  This resulted in for every 10 benign lumps that were referred to
specialist centers, one was malignant.  It took ten years to make this
difference, and the next ten years the statistics have leveled out.  They found
that mostly, there was no pain involved, the lumps were incidentally found.
They emphasized that it took ten years to really make a difference.

They also mentioned that in Scandinavia, there is NO economic reason to keep a
patient (they have a national health system).  This caused some murmurs from the
attendees.  This was an international gathering of sarcoma specialists, and many
of them from the US which DOES have a profit motive (in some respect).  But
these US specialists would also be the recipients of the patient referrals, not
necessarily the referring doctors.

Anyway, I think that the positive aspects of this presentation was that it needs
to begin with the medical schools, and letters (from someone) to those doctors
that comply with the new guidelines.  And that the effect of the imposition of
the new treatment guidelines doesn't take effect overnight.

I hope this is useful information,

As always, my thoughts are with everyone going forward with HOPE.

Dave Murphy - LA, Ca
Husband to Piera  11/5/57-10/28/99
8/98 dx LMS
11/98 dx chg'd to MFH

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