Patient surveillance after treatment for soft-tissue sarcoma

Abstract

Abstract. About 1% of all cancers are soft tissue sarcomas (STS); about 60% of these occur in the extremities. Posttreatment surveillance programs are designed to identify recurrence, new primary cancers, and complications of therapy early enough to increase survival duration and quality of life. The intensity of surveillance varies among surgeons. We hypothesized that geographic factors would account for much of this variation. The 1,592 members of the Society of Surgical Oncology were surveyed regarding their personal postoperative STS surveillance strategy using standardized clinical vignettes and a questionnaire based on the vignettes. Practice patterns were analyzed by US Census Region, Metropolitan Statistical Area (MSA), and managed care organization (MCO) penetration rate, using repeated measures analysis of variance. The study end-point was surveillance intensity. Mean follow-up intensity for the 12 surveillance modalities on the questionnaire was highly correlated with tumor size, grade, and year post surgery. Controlling for tumor stage, grade, and year post surgery, the practice location of the surgeon infrequently impacted surveillance intensity. MSA was a significant (p<0.05) predictor only of office visit frequency. MCO penetration rate significantly predicted only the frequency of urinalysis and tumor-site MRI. US Census Region significantly predicted only the frequency of LFTs. Geographic factors do not generally predict self-reported surveillance practice patterns for patients after curative-intent STS surgery. The overall variation in follow-up intensity appears to reflect factors not evaluated, such as the absence of high-quality evidence supporting any particular strategy and the quality of patients' insurance.

Follow‐up of the soft tissue sarcoma patient

“…A separate analysis of the survey data showed little impact on surveillance strategy with surgeon age and experience; the only difference was more frequent use of erythrocyte sedimentation rate, extremity X‐rays and bone scans among the older surgeons . Several years later, another analysis of the survey data was done which found little to no variation in surveillance strategies by US metropolitan and geographic areas or level of managed care organization penetration .…”

Follow-up Strategies for Primary Extremity Soft-tissue Sarcoma in Adults: A Systematic Review of the Published Literature

“…Recent published studies have revealed a yearly incidence of about 4-5/100,000 in Europe; liposarcoma and leiomyosarcoma are the most common histological subtypes (15-17). Nearly every third patient with primarily local STS will develop DM during the follow-up period, most likely in the lungs (18).The large majority of STS are primarily located in the extremities; about 40% occur in the lower limbs (1,2,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The second most frequent location is the abdomen (retroperitoneal or visceral); the lesions are usually very voluminous at the time of presentation (1,(19)(20)(21)(22)(23).…”

“…The large majority of STS are primarily located in the extremities; about 40% occur in the lower limbs (1,2,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The second most frequent location is the abdomen (retroperitoneal or visceral); the lesions are usually very voluminous at the time of presentation (1,(19)(20)(21)(22)(23).…”

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

“…However, the ideal postoperative protocol, particularly the frequency of followup and appropriate screening modalities for these uncommon neoplasms, remains ill defined [8,10,18]. Current guidelines are not based on high-quality evidence [10,18]. Current postoperative surveillance regimes are empirical and vary widely from center to center [8,9,18].…”

“…With improved patient survival, followup surveillance strategies are becoming increasingly important with considerable clinical and fiscal implications. However, the ideal postoperative protocol, particularly the frequency of followup and appropriate screening modalities for these uncommon neoplasms, remains ill defined [8,10,18]. Current guidelines are not based on high-quality evidence [10,18].…”