The shape of soft tissue sarcoma services in Northern Ireland: An audit to evaluate current practice

Audit current practice of referral patterns, investigations and management of patients with soft tissue sarcoma across Northern Ireland.

Sarcomas are a rare and diverse group of cancers which can make management challenging. An orthopaedic hospital based specialised sarcoma service was established in the late 1990s in Northern Ireland in an attempt to streamline referrals pathways for suspected bone and soft tissue sarcomas and optimise management through a dedicated multi-disciplinary team.

The standard: 

Recommendations from the British sarcoma management guidelines 2010 and improving outcomes guidelines 2006:

• MDT discussion for all new diagnosis

• Chest imaging prior radical surgery in all patients

• Pathology report should include grade, size and margin

Target: 

• All newly diagnosed should be discussed in MDT - 100%

• Imaging of the thorax by CT scan for lung metastases should be done prior to radical treatment - 100%

• The histo-pathology report should include an appropriate description of tumour margins - 100%

• Tumour size and grade should be included in histo-pathology report - 100%

• A soft tissue sarcoma MDT should meet minimum criteria and manage the care of at least 100 new patients with soft tissue sarcoma per year

Indicators: 

The data will show no significant difference from the standard.

Data items to be collected: 

• Patient demographics

• Referral source

• MDT discussion

• Time to treatment

• Imaging

• Subtypes

• Completeness of excision

Suggested number: 

>100

• Introduction of cancer network for sarcoma to facilitate regional pathways

• Dedicated education and audit day for sarcoma team

• Coordination between sarcoma and regional MDTS

• Re audit in 1 year

- Personnel: Clinical Oncologist, Radiologist, Specialised sarcoma surgeons, Orthopaedics and general surgeons and specialist Nurse

- Estimated time: 40-50 hours to review records, complete data collection and analysis

1. Grimer R, Judson I, Peake D, Seddon B :Guidelines for the management of soft tissue sarcomas. Sarcoma. 2010;2010:506182. doi: 10.1155/2010/506182. Epub 2010 May 31.

2. Improving Outcomes for People with Sarcoma March 2006 by the National Collaborating Centre for Cancer.

Prantik Das