Childhood cancers

Treatment variations affect outcomes for young adult patients with sarcoma

Most adolescents and young adults with sarcoma are receiving appropriate care in Australian hospitals but there are some variations in care, particularly for Ewing’s sarcoma.

In the first national review of sarcoma management in Australia, chemotherapy protocols and survival rates were found to be mostly similar across 61 different treatment centres.

The review, carried out by researchers in Victoria looked at treatments and outcomes for 318 15–24 year-olds diagnosed with soft tissue sarcoma, bone sarcoma, and Ewing family tumours (ET) between 2007 and 2012.

Most patients received a combination of chemotherapy and surgery/radiotherapy, although some patients with Ewing’s sarcoma did not receive a standard chemotherapy protocol as part of their care and had poorer survival outcomes.

The greatest variations in care were seen for patients with bone sarcoma, particularly when patients were treated in a hospital that was not a specialist centre or had dedicated Youth Cancer Services, where non-standard protocols were used in 40-58% of patients.

For young adults (18–24 year-olds), 82% of bone sarcoma, 90% of Ewing’s sarcoma, and 73% of rhabdomyosarcomas at adult specialist centres were on a trial or standard protocol, compared with 42%, 89%, and 100%, respectively, at non-specialist adult hospitals.

However after adjusting for disease and patient characteristics, survival was not associated with treatment centre type for any disease type.

For patients with soft tissue sarcoma the five-year overall survival rates were 86% for localised disease and 26% for metastatic disease. For bone sarcoma, the OS rates were 78% and 22%, respectively, while for Ewing’s sarcoma the OS rates were 50% for localised disease and 27% for metastatic disease.

“ … it is possible that the results reflect efforts undertaken in Australia to increase expertise in the treatment of adolescents and young adults with cancer  and sarcoma, which have included the development of network-wide clinical multidisciplinary team meetings to help ensure access to clinical expertise,” the authors said.

However they also noted that 10% of Ewing’s sarcoma patients did not receive standard chemotherapy, and this was associated with lower survival rates (Hazard Ratio for death =3.48).

“Although only a few ET patients did not receive a standard chemotherapy protocol as part of their care, this association with poorer survival suggests efforts are needed to ensure that all patients are receiving optimal care,” they concluded.

The study from the Centre for Behavioral Research in Cancer, Cancer Council Victoria, is published in the Journal of Adolescent and Young Adult Oncology.

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