title: Adherence to consensus-based diagnosis and treatment guidelines in adult soft-tissue sarcoma patients: a French prospective population-based study.
abstract: BACKGROUND
  Soft-tissue sarcomas (STSs) are rare tumors with varied histological presentations. Management and treatment are thus complex, but crucial for patient outcomes. We assess adherence to adult STS management guidelines across two French regions (10% of the French population). We also report standardized incidence.
  
  
  METHODS
  STS patients diagnosed from 1 November 2006 to 31 December 2007 were identified from pathology reports, medical hospital records, and cancer registries. Guideline adherence was assessed by 23 criteria (validated by Delphi consensus method), and age and sex-standardized incidence rates estimated. Associations between patient, treatment, and institutional factors and adherence with three major composite criteria relating to diagnostic imaging and biopsy as well as multidisciplinary team (MDT) case-review are reported.
  
  
  RESULTS
  Two hundred and seventy-four patients were included (57.7% male, mean age 60.8 years). Practices were relatively compliant overall, with over 70% adherence for 10 criteria. Three criteria with perfect Delphi consensus had low adherence: receiving histological diagnosis before surgery, adequacy of histological diagnosis (adherence around 50% for both), and MDT discussion before surgery (adherence <30%). Treatment outside of specialized centers was associated with lower adherence for all three composite criteria, and specific tumor sites and/or features were associated with lower adherence for diagnostic imaging, methods, and MDT meetings. STS standardized incidence rates were 4.09 (European population) and 3.33 (World) /100 000 inhabitants.
  
  
  CONCLUSIONS
  Initial STS diagnosis and treatment across all stages (imaging, biopsy, and MDT meetings) need improving, particularly outside specialized centers. Educational interventions to increase surgeon's sarcoma awareness and knowledge and to raise patients' awareness of the importance of seeking expert care are necessary.
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux.
authors.forename: S
authors.initials: S
authors.lastname: Mathoulin-Pélissier
authors.forename: C
authors.initials: C
authors.lastname: Chevreau
authors.forename: C
authors.initials: C
authors.lastname: Bellera
authors.forename: E
authors.initials: E
authors.lastname: Bauvin
authors.forename: M
authors.initials: M
authors.lastname: Savès
authors.forename: P
authors.initials: P
authors.lastname: Grosclaude
authors.forename: S
authors.initials: S
authors.lastname: Albert
authors.forename: J
authors.initials: J
authors.lastname: Goddard
authors.forename: S
authors.initials: S
authors.lastname: Le Guellec
authors.forename: M
authors.initials: M
authors.lastname: Delannes
authors.forename: B N
authors.initials: BN
authors.lastname: Bui
authors.forename: J
authors.initials: J
authors.lastname: Mendiboure
authors.forename: E
authors.initials: E
authors.lastname: Stoeckle
authors.forename: J M
authors.initials: JM
authors.lastname: Coindre
authors.forename: G
authors.initials: G
authors.lastname: Kantor
authors.forename: M
authors.initials: M
authors.lastname: Kind
authors.forename: A
authors.initials: A
authors.lastname: Cowppli-Bony
authors.forename: S
authors.initials: S
authors.lastname: Hoppe
authors.forename: A
authors.initials: A
authors.lastname: Italiano
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000628:therapy*
keywords: Delphi technique; guideline adherence; health care; incidence; quality indicators; soft-tissue sarcoma