Routes to diagnosis for sarcoma - Describing the sarcoma patient journey.
BACKGROUND
Understanding the route to diagnosis for patients with cancer is important to improve the diagnostic pathway and therefore outcomes. We aimed to investigate routes to diagnosis for patients with sarcoma in England.


METHODS
National patient level datasets relating to 7716 soft tissue and 1240 bone sarcoma patients diagnosed between 2006 and 2008 were analysed. Routes to diagnosis were defined as: "Two Week Wait Referral", "GP Referral", "Other Outpatient", "Inpatient Elective", "Emergency Presentation", "Death Certificate Only" and "Unknown".


RESULTS
Patients with sarcoma are most likely to be diagnosed after "GP Referral" or "Emergency Presentation" and are less likely to be referred under a two week wait compared with other malignancies. Patients with bone sarcoma under 10 or over 80 years of age were more likely to present by emergency routes, as were patients with vertebral column, pelvis or unspecified site tumours and those with Ewing's sarcoma or sarcoma NOS. Patients with soft tissue sarcoma under 19 or over 80 years of age and patients with GI tract tumours were more likely to present by emergency routes. Patients presenting by emergency routes more often had metastases and had lower 1 year survival. Patients from least deprived quintiles more often presented by unknown routes: those from more deprived quintiles more often presented by emergency routes.


CONCLUSIONS
Routes to diagnosis for sarcoma patients differ from other cancers. Interventions to improve the diagnostic experience should consider the very young and elderly, tumours in abdominal, pelvic or spinal locations and on reducing emergency presentations.
North of England Bone and Soft Tissue Tumour Service, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, UK. Electronic address: Craig.gerrand@nuth.nhs.uk.
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Gerrand
Public Health England Knowledge and Intelligence Team (West Midlands), Public Health England, 1st Floor, 5 St Philips Place, Birmingham, B3 2PW, UK. Electronic address: matthew.francis@phe.gov.uk.
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Francis
Public Health England Knowledge and Intelligence Team (West Midlands), Public Health England, 1st Floor, 5 St Philips Place, Birmingham, B3 2PW, UK. Electronic address: Nicola.dennis@phe.gov.uk.
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Dennis
Public Health England Knowledge and Intelligence Team (West Midlands), Public Health England, 1st Floor, 5 St Philips Place, Birmingham, B3 2PW, UK.
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Charman
Public Health England Knowledge and Intelligence Team (West Midlands), Public Health England, 1st Floor, 5 St Philips Place, Birmingham, B3 2PW, UK. Electronic address: oldpogill@gmail.com.
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Lawrence
Public Health England Knowledge and Intelligence Team (West Midlands), Public Health England, 1st Floor, 5 St Philips Place, Birmingham, B3 2PW, UK.
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Evans
Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK. Electronic address: Robert.grimer@nhs.net.
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Grimer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001859:Bone Neoplasms / Q000175:diagnosis*; D002648:Child; D002813:Chondrosarcoma / Q000175:diagnosis; D019091:Critical Pathways; D004630:Emergencies; D004739:England; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000175:diagnosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012208:Rhabdomyosarcoma / Q000175:diagnosis; D012509:Sarcoma / Q000175:diagnosis*; D012512:Sarcoma, Ewing / Q000175:diagnosis; D012983:Soft Tissue Neoplasms / Q000175:diagnosis*; D055815:Young Adult
Accidents; Referral and consultation; Sarcoma; Survival rate