Elyes Maria, Heesen Philip, Schelling Georg, Bode-Lesniewska Beata, Studer Gabriela, Fuchs Bruno
University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland.
University Hospital USZ, Sarcoma Servuce, University of Zurich, 8000 Zurich, Switzerland.
Cancers (Basel). 2023 Oct 9;15(19):4892. doi: 10.3390/cancers15194892.
Sarcomas, rare and with lower survival rates than common tumors, offer insights into healthcare efficiency via the analysis of the total interval of the diagnostic pathway, combining the patient interval (time between the first symptom and visit with a physician) and diagnostic interval (time between first physician visit and histological diagnosis). Switzerland's healthcare system, Europe's costliest, lacks research on treating rare conditions, like mesenchymal tumors. This study examines the total interval of the diagnostic pathway for optimization strategies. Analyzing a dataset of 1028 patients presented from 2018 to 2021 to the Swiss Sarcoma Board (MDT/SB-SSN), this retrospective analysis delves into bone sarcoma (BS), soft-tissue sarcoma (STS), and their benign counterparts. Demographic and treatment data were extracted from medical records. The patient interval accounted for the largest proportion of the total interval and secondary care interval for the largest proportion of the diagnostic interval. Age, grade, and localization could be elicited as influencing factors of the length of different components of the total interval. An increasing age and tumor size, as well as the axial localization, could be elicited as factors increasing the probability of sarcoma. The patient and secondary care interval (SCI) offer the greatest potential for optimization, with SCI being the bottleneck of the diagnostic interval. New organizational structures for care work-ups are needed, such as integrated practice units (IPU) as integral part of value-based healthcare (VBHC).
肉瘤较为罕见，生存率低于常见肿瘤，通过分析诊断路径的总间隔（包括患者间隔，即首次出现症状与就医之间的时间，以及诊断间隔，即首次就医与组织学诊断之间的时间），能为医疗效率提供见解。瑞士的医疗体系是欧洲最昂贵的，但缺乏对治疗罕见疾病（如间充质肿瘤）的研究。本研究考察诊断路径的总间隔以寻求优化策略。通过分析2018年至2021年提交给瑞士肉瘤委员会（MDT/SB - SSN）的1028例患者的数据集，这项回顾性分析深入研究了骨肉瘤（BS）、软组织肉瘤（STS）及其良性对应物。人口统计学和治疗数据从医疗记录中提取。患者间隔在总间隔中占比最大，二级护理间隔在诊断间隔中占比最大。年龄、分级和部位可被确定为影响总间隔不同组成部分长度的因素。年龄增长、肿瘤大小增加以及轴向部位可被确定为增加肉瘤发生概率的因素。患者和二级护理间隔（SCI）具有最大的优化潜力，其中SCI是诊断间隔的瓶颈。需要新的检查护理组织结构，比如作为基于价值的医疗保健（VBHC）组成部分的综合诊疗单元（IPU）。
