1. Territorial inequalities in management and conformity to clinical guidelines for sarcoma patients: an exhaustive population-based cohort analysis in the Rhône-Alpes region.
- Author
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Heudel, Pierre, Cousin, Philippe, Lurkin, Antoine, Cropet, Claire, Ducimetiere, Françoise, Collard, Olivier, Laroche, Guy, Biron, Pierre, Meeus, Pierre, Thiesse, Philippe, Bergeron, Christophe, Vaz, Gualter, Mithieux, François, Farsi, Fadila, Fayet, Yohan, Gilly, François-Noel, Cellier, Dominic, Blay, Jean-Yves, and Ray-Coquard, Isabelle
- Subjects
SARCOMA ,CLINICAL trials ,COHORT analysis ,HISTOPATHOLOGY ,OSTEOSARCOMA ,PATIENTS - Abstract
Background: Sarcomas are rare cancers with great variability in clinical and histopathological presentation. The main objective of clinical practice guidelines (CPGs) is to standardize diagnosis and treatment. Methods: From March 2005 to February 2007, all patients diagnosed with localized sarcoma in the Rhône-Alpes region were included in a cohort-based study, to evaluate the compliance of sarcoma management with French guidelines in routine practice and to identify predictive factors for compliance with CGPs. Results: 634 (71 %) patients with localized sarcoma satisfying the inclusion criteria were included out of 891 newly diagnosed sarcomas. Taking into account initial diagnosis until follow-up, overall conformity to CPGs was only 40 % [95 % confidence interval (CI) = 36-44], ranging from 54 % for gastrointestinal stromal tumor to 36 % for soft tissue sarcoma and 42 % for bone sarcoma. In multivariate analysis, primary tumor type [relative risk (RR) = 4.42, 95 % CI = 2.79-6.99, p < 0.001], dedicated multidisciplinary staff before surgery (RR = 4.19, 95 % CI = 2.39-7.35, p < 0.001) and management in specialized hospitals (RR = 3.71, 95 % CI = 2.43-5.66, p < 0.001) were identified as unique independent risk factors for conformity to CPGs for overall treatment sequence. Conclusions: With only 40 % of total conformity to CPGs, the conclusions support the improvement of initial sarcoma management and its performance in specialized centres or within specialized dedicated networks. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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