Factors favouring palliative treatment multidisciplinary decisions for newly diagnosed visceral and soft tissue sarcomas.
OBJECTIVE
The multidisciplinary medical decision-making process is a key element of the clinical management of cancers, especially rare cancers such as visceral and soft tissue sarcomas. One of the most important decisions stated is to discriminate patients considered for palliative-intent treatment. The aim of this retrospective study was to establish the rationale parameters that justify this decision for newly diagnosed sarcomas.


METHODS
From a retrospective cohort of 341 patients we investigated the parameters justifying a palliative-intent strategy decision in univariate and multivariate analyses, based on the logistic regression model. We also measured the effect of this decision on overall survival using the Cox model.


RESULTS
Seventy-one of 341 patients (20%) were considered for a palliative-intent strategy. In multivariate analysis, five variables justified this decision: contraindication for general anaesthesia (adjusted odds ratio 10.5), head and neck location (odds ratio 3.7), visceral sarcoma (odds ratio 2.8), tumour size over 8 cm (odds ratio 3.5) and presence of metastasis (odds ratio 39.5). In the Cox model we found that two independent factors were associated with poor outcome: grade 3 (hazard ratio 2.7) and palliative-intent strategy (hazard ratio 3.3).


CONCLUSIONS
About 20% of newly diagnosed sarcomas were considered for palliative strategy by multidisciplinary committee. This decision was based on rationale parameters and had an intrinsic prognostic value.
Penel
N
N
Département de Cancérologie Générale, Centre Oscar Lambret, Equipe d'Accueil 2694: Santé Publique, Epidémiologie et modélisation des maladies chroniques, Université Lille II, Lille, France. n-penel@o-lambret.fr
Grosjean
J
J
Pichon-Watelle
F
F
Giscard
S
S
Hoppe
H
H
Taieb
S
S
Vanseymortier
L
L
Adenis
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis