Martin Eichler1,2, Dimosthenis Andreou3,4, Henriette Golcher5, Leopold Hentschel2, Stephan Richter1, Peter Hohenberger6, Bernd Kasper7, Daniel Pink4,8, Jens Jakob9, Hany Ashmawy10, Simone Hettmer11, Armin Tuchscherer12, Matthias Grube13, Vitali Heidt14, Christina Jentsch2,15, Jessica Pablik2,16, Eva Wardelmann17, Karl-Friedrich Kreitner18, Ulrich Kneser19, Carolin Tonus20, Pauline Wimberger2,21,22, Olaf Schoffer2,23, Peter Reichardt24, Markus Wartenberg25, Maria Eberlein-Gonska26, Martin Bornhäuser1,2, Jochen Schmitt2,23, Markus K Schuler1. 1. Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany. 2. National Center for Tumor Diseases (NCT/UCC), Dresden, Germany. 3. Department of General Orthopedics and Tumor Orthopedics, University Hospital Münster, Münster, Germany. 4. Sarcoma Center Berlin-Brandenburg, Helios Hospital, Bad Saarow, Germany. 5. Clinic for Surgery, University Hospital Erlangen, Erlangen, Germany. 6. Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany. 7. Interdisciplinary Tumor Center, Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany. 8. Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany. 9. Clinic for General, Visceral, and Pediatric Surgery, University Hospital Goettingen, Goettingen, Germany. 10. Clinic for General, Visceral, and Pediatric Surgery, University Hospital Dusseldorf, Dusseldorf, Germany. 11. Center of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany. 12. University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany. 13. Clinic and Polyclinic for Internal Medicine III, University Hospital Regensburg, Regensburg, Germany. 14. The Scientific Institute of Office-Based Hematologists and Oncologists, Cologne, Germany. 15. Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany. 16. Institute for Pathology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany. 17. Gerhard Domagk Institute for Pathology, University Hospital Münster, Münster, Germany. 18. Clinic and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Mainz, Mainz, Germany. 19. Department of Hand, Plastic, Reconstructive and Microsurgery, BG Trauma Center Ludwigshafen and Heidelberg University, Ludwigshafen, Germany. 20. Clinic for General and Visceral Surgery, Asklepios Hospital St. Georg Hamburg, Hamburg, Germany. 21. Clinic and Polyclinic for Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany. 22. German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany. 23. Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany. 24. Sarcoma Center Berlin-Brandenburg, Helios Hospital Berlin Buch, Berlin, Germany. 25. German Sarcoma Foundation, Wölfersheim, Germany. 26. Department of Quality and Medical Risk Management, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
Abstract
BACKGROUND: Data on institutional structures of sarcoma care in Germany are scarce. The utilization of an interdisciplinary tumor board (IDTB) is an essential part of modern cancer care. We investigated to which extent and when IDTB are used in sarcoma care. We hypothesized that IDTB before treatment initiation were used more often at certified cancer centers and at high-volume centers and that IDTB utilization increased over time. METHODS: From 2017 to 2020 we conducted a prospective cohort study, undertaking major efforts to include the whole spectrum of sarcoma treatment facilities. To analyze potential predictors of IDTB utilization, we calculated multivariable logistic regressions. RESULTS: Patients and survivors (n = 1,309) from 39 study centers (22 tertiary referral hospitals, 9 other hospitals, and 8 office-based practices) participated; 88.3% of the patients were discussed at some stage of their disease in an IDTB (56.1% before treatment, 78% after therapy, and 85.9% in metastatic disease). Hypotheses were confirmed regarding the utilization of IDTB in certified cancer centers (vs. all others: OR = 5.39; 95% CI 3.28-8.85) and the time of diagnosis (2018/2019 vs. until 2013: OR = 4.95; 95% CI 2.67-9.21). CONCLUSION: Our study adds to the evidence regarding the institutional structures of sarcoma care in Germany. Utilization of a tumor board before therapy seems to be in an implementation process that is making progress but is far from complete. Certification is a possible tool to accelerate this development.
BACKGROUND: Data on institutional structures of sarcoma care in Germany are scarce. The utilization of an interdisciplinary tumor board (IDTB) is an essential part of modern cancer care. We investigated to which extent and when IDTB are used in sarcoma care. We hypothesized that IDTB before treatment initiation were used more often at certified cancer centers and at high-volume centers and that IDTB utilization increased over time. METHODS: From 2017 to 2020 we conducted a prospective cohort study, undertaking major efforts to include the whole spectrum of sarcoma treatment facilities. To analyze potential predictors of IDTB utilization, we calculated multivariable logistic regressions. RESULTS:Patients and survivors (n = 1,309) from 39 study centers (22 tertiary referral hospitals, 9 other hospitals, and 8 office-based practices) participated; 88.3% of the patients were discussed at some stage of their disease in an IDTB (56.1% before treatment, 78% after therapy, and 85.9% in metastatic disease). Hypotheses were confirmed regarding the utilization of IDTB in certified cancer centers (vs. all others: OR = 5.39; 95% CI 3.28-8.85) and the time of diagnosis (2018/2019 vs. until 2013: OR = 4.95; 95% CI 2.67-9.21). CONCLUSION: Our study adds to the evidence regarding the institutional structures of sarcoma care in Germany. Utilization of a tumor board before therapy seems to be in an implementation process that is making progress but is far from complete. Certification is a possible tool to accelerate this development.
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