Territorial inequalities in management and conformity to clinical guidelines for sarcoma patients: an exhaustive population-based cohort analysis in the Rhône-Alpes region.
BACKGROUND
Sarcomas are rare cancers with great variability in clinical and histopathological presentation. The main objective of clinical practice guidelines (CPGs) is to standardize diagnosis and treatment.


METHODS
From March 2005 to February 2007, all patients diagnosed with localized sarcoma in the Rhône-Alpes region were included in a cohort-based study, to evaluate the compliance of sarcoma management with French guidelines in routine practice and to identify predictive factors for compliance with CGPs.


RESULTS
634 (71 %) patients with localized sarcoma satisfying the inclusion criteria were included out of 891 newly diagnosed sarcomas. Taking into account initial diagnosis until follow-up, overall conformity to CPGs was only 40 % [95 % confidence interval (CI) = 36-44], ranging from 54 % for gastrointestinal stromal tumor to 36 % for soft tissue sarcoma and 42 % for bone sarcoma. In multivariate analysis, primary tumor type [relative risk (RR) = 4.42, 95 % CI = 2.79-6.99, p < 0.001], dedicated multidisciplinary staff before surgery (RR = 4.19, 95 % CI = 2.39-7.35, p < 0.001) and management in specialized hospitals (RR = 3.71, 95 % CI = 2.43-5.66, p < 0.001) were identified as unique independent risk factors for conformity to CPGs for overall treatment sequence.


CONCLUSIONS
With only 40 % of total conformity to CPGs, the conclusions support the improvement of initial sarcoma management and its performance in specialized centres or within specialized dedicated networks.
Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France, pierre-etienne.heudel@lyon.unicancer.fr.
Pierre Etienne
PE
Heudel
Philippe
P
Cousin
Antoine
A
Lurkin
Claire
C
Cropet
Françoise
F
Ducimetiere
Olivier
O
Collard
Guy
G
De Laroche
Pierre
P
Biron
Pierre
P
Meeus
Philippe
P
Thiesse
Christophe
C
Bergeron
Gualter
G
Vaz
François
F
Mithieux
Fadila
F
Farsi
Yohan
Y
Fayet
François-Noel
FN
Gilly
Dominic
D
Cellier
Jean-Yves
JY
Blay
Isabelle
I
Ray-Coquard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D012509:Sarcoma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*