Organization of Bone Sarcoma Care: A Cross-Sectional European Study

Abstract

Objective: To assess organization of care in several bone sarcoma centers in Europe affiliated with the European Musculoskeletal Oncology Society (EMSOS) for comparison and to identify potential improvements in organization of care.

Methods: Data for this observational cross-sectional study was obtained through healthcare professionals affiliated to EMSOS. The authors formulated 10 questions regarding organization of care. The questions were focused on guidance, multidisciplinary decision-making, and data storage. A digital questionnaire was synthesized and included quality control. The digital questionnaire was sent to 54 representative members of EMSOS. We did not receive responses from 29 representative countries (53.7%) after one digital invitation and two digital reminders.

Results: We received data from 25 representatives of bone sarcoma centers from 17 countries across Europe (46.3%). Authorization to perform oncological care in a bone sarcoma center was government issued in 41.2% of cases and based on expertise without governmental influence in 52.9% of cases. In 64.7% of the countries, a national bone tumor guideline regarding for diagnosis and treatment is used in oncological care. A national bone tumor board for extensive case evaluation including classification and advice for treatment is available for 47.1% of the countries. All participating bone sarcoma centers have a mandatory local multidisciplinary meeting before the start of treatment; in 84.0% this meeting takes place once a week. During this multidisciplinary meeting a median of 15 cases (range, 4-40 cases) are discussed. In terms of storage of oncological data, a local registry is used in eight countries (47.1%). A national registry is used in eight countries (47.1%).

Conclusions: A national bone tumor board gives bone sarcoma centers with little adherence the opportunity to gain knowledge from a more experienced team. Centralization of care in a bone sarcoma center is important to lower incidences. The optimal size for a bone sarcoma center in terms of patient adherence is not known at present.

Keywords: Bone sarcoma; Centralization; Organization of care.

Figure 1

Flowchart of the study design.

Figure 2

Geographical dispersion across Europe of responding bone sarcoma centres. 1. Netherlands: University Medical Center Groningen, Leiden University Medical Center. 2. Belgium: Jules Bordet Institute Brussels. 3. Germany: Medical Center of the University of Munich, Stuttgart Cancer Center Olgahospital. 4. United Kingdom: University College Hospital London, Royal Orthopedic Hospital Birmingham. 5. France: Limoges Teaching Hospital, University Hospital Hotel‐Dieu Nantes, Hospital Cochin Paris. 6. Spain: Hospital Universitario de Bellvitge Barcelona, Hospital Universitario La Paz Madrid. 7. Italy: Centro Traumatologico Ortopedico Florence, Regina Elena National Cancer Institute Rome, Cancer Institute G. Pascal Foundation Naples. 8. Norway: Oslo University Hospital. 9. Sweden: Karolinska Hospital Stockholm. 10. Finland: Helsinki University Central Hospital. 11. Austria: Medical University of Graz. 12. Switzerland: Balgrist University Hospital Zürich. 13. Poland: Pomeranian Medical University of Szczecin. 14. Slovenia: Ljubljana University Medical Centre. 15. Serbia: Institute for Oncology and Radiology Belgrade. 16. Ukraine: National Cancer Institute Kiev. 17. Turkey: Acibadem Maslak Hospital Istanbul.