The Influence of Danish Cancer Patient Pathways on Survival in Deep-Seated, High-Grade Soft-Tissue Sarcomas in the Extremities and Trunk Wall: A Retrospective Observational Study.

BACKGROUND

Soft-tissue sarcomas (STSs) are rare and challenging to diagnose due to their heterogeneous presentation. In 2009, Denmark introduced the Cancer Patient Pathways for sarcomas (CPPs) to improve sarcoma treatment by streamlining diagnostic and therapeutic processes. The primary objective of this study is to evaluate the impact of the CPPs on the overall survival of patients with deep-seated, high-grade STSs, comparing outcomes from before and after CPP implementation.

METHODS

A retrospective cohort study was conducted using data from 712 patients diagnosed with high-grade STSs in the extremities or trunk wall between 2000 and 2018. Patients were grouped into pre-CPP (2000-2008) and post-CPP (2010-2018) cohorts. Overall survival was analyzed using Kaplan-Meier estimates.

RESULTS

The five-year overall survival improved from 43% in the pre-CPP cohort to 52% post-CPP ( = 0.05). Time-to-treatment was significantly reduced in the post-CPP cohort, with a median decrease of 3 days (18 vs. 15 days, < 0.001). We found only a very weak tendency toward larger tumor sizes in the pre-CPP cohort and no difference regarding the percentage of patients that had distant metastases at diagnosis between cohorts. In the post-CPP cohort, the percentage of whoops operations decreased and the use of oncological services increased.

CONCLUSIONS

After the introduction of the CPPs for the sarcoma patients, overall survival improved and time to treatment was reduced. This study highlights the importance of efficient referral pathways in improving cancer outcomes but cannot exclude that other factors could also have contributed.