title: Influence of physician specialty on treatment recommendations in the multidisciplinary management of soft tissue sarcoma of the extremities.
abstract: OBJECTIVE
  Although prospective randomized data are available to guide the multidisciplinary management of soft tissue sarcoma (STS) of the extremities, controversy exists regarding adjuvant chemotherapy and radiation therapy.
  
  
  OBJECTIVE
  To determine if clinical specialty introduces bias in recommendations for multimodality treatment of STS.
  
  
  METHODS
  Electronic survey.
  
  
  METHODS
  Database of active members of the American Society of Clinical Oncology, the Society of Surgical Oncology, and the Connective Tissue Oncology Society.
  
  
  METHODS
  Members of specialty oncology societies with an active interest in STS.
  
  
  METHODS
  Physician specialty.
  
  
  METHODS
  Survey responses regarding the multidisciplinary management of STS were scored on a 5-point Likert scale and analyzed using analysis of variance.
  
  
  RESULTS
  The questionnaire was completed by 320 of 490 potential respondents (65%), including medical (18%), radiation (8%), orthopedic (22%), and surgical oncologists (45%). Respondents concurred on the use of radiation therapy for margins positive for tumor, for high-grade tumors, for improvement in local control, for tumors larger than 10 cm, and for tumors in close proximity to a neurovascular bundle. Respondents diverged on the use of radiation therapy for tumors 5 to 10 cm in size, for low-grade tumors, for radiation-associated STS, and for survival benefit. Only radiation oncologists felt that radiation therapy was underutilized as a treatment modality (mean [SEM] Likert scale score, 2.44 [0.12]; P < .001). There was agreement on the use of chemotherapy for synovial sarcoma, for high-grade tumors, for tumors larger than 10 cm, for patients younger than 50 years of age, and for survival benefit. Medical oncologists were more likely to recommend chemotherapy for margins positive for tumor (mean [SEM] score, 3.12 [0.12]; P = .03) and for improvement in local control (mean [SEM] score, 2.91 [0.12] P = .08). Surgical oncologists placed the least emphasis on chemotherapy in the overall treatment plan (mean [SEM] score, 2.60 [0.07]; P = .001).
  
  
  CONCLUSIONS
  Specialty bias exists in adjuvant treatment recommendations for STS. This highlights the importance of multidisciplinary STS tumor boards and interdisciplinary care to facilitate consensus decision making for individual patients.
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Scottsdale, USA. wasif.nabil@mayo.edu
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Caitlin A
authors.initials: CA
authors.lastname: Smith
authors.forename: Robert M
authors.initials: RM
authors.lastname: Tamurian
authors.forename: Scott D
authors.initials: SD
authors.lastname: Christensen
authors.forename: Arta M
authors.initials: AM
authors.lastname: Monjazeb
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Canter
mesh_terms: D006801:Humans; D008495:Medical Oncology; D010348:Patient Care Team; D010818:Practice Patterns, Physicians'; D018787:Radiation Oncology; D012509:Sarcoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011795:Surveys and Questionnaires