Mixed Outcomes From Multidisciplinary Sarcoma Clinic

The implementation of a dedicated sarcoma multidisciplinary clinic (MDC) at a tertiary cancer center did not significantly reduce the time to treatment initiation (TTI) for patients with soft tissue sarcoma, but it was associated with a notable increase in the use of multimodal therapy. These findings, published in the Journal of Surgical Oncology, offer insight into the role of specialized clinics in managing complex rare cancers.¹

Soft tissue sarcomas represent just 1% of all cancers in the US but are linked to high mortality and complex treatment needs. Roughly 60% of patients present with localized disease, with a 5-year survival of 81%, while metastatic presentations carry a 5-year survival of less than 20%. Prior research suggests that a TTI exceeding 50 days is associated with significantly worse overall survival in patients with high-grade soft tissue sarcoma.²

The authors highlight that “It is important to acknowledge that while reducing TTI may be intuitively important and can address the sense of urgency that many patients experience when they receive a cancer diagnosis, it is unknown whether reducing TTI has a true impact on clinical outcomes such as survival for soft tissue sarcoma, which is generally an aggressive malignancy with high risk of disease‐specific mortality.”¹

To evaluate this relationship, investigators at the University of Alabama at Birmingham (UAB) conducted a retrospective cohort study that included 275 patients treated between November 2021 and January 2024, comparing those seen in a dedicated sarcoma MDC (n = 33) with those managed in single-specialty clinics (usual care, n = 242). The majority of patients were diagnosed with a localized primary tumor (75.6%), with a median age of 57 years.

The primary study outcome was TTI, measured in days from the initial consultation to the first treatment (surgery, radiation, or systemic therapy). Treatment delay was defined as a TTI greater than 50 days, a threshold established by prior national cancer registry data. Researchers found there was not a statistically significant difference in median TTI between MDC (31 days) and usual care (34 days; P = .47).

However, nearly 30% of patients experienced a delay of more than 50 days between evaluation and initiation of treatment (MDC 15.2%, usual care 31.8%; P = .05). The most common reasons for delayed therapy included the need for further diagnostic imaging or evaluation (35%), patient or social factors (50%), preoperative testing (12%), treatment at outside facilities (12%), scheduling challenges (8.5%), and insurance barriers (3.6%). Patient preference for local delivery of radiation or systemic therapy contributed substantially to delays, reflecting logistical hurdles for rural populations traveling long distances to high-volume centers.

Furthermore, the study found that patients managed in the MDC were substantially more likely to receive multimodal therapy (75.8%) compared with those in usual care (41.7%; P < .01). Radiation was far more commonly selected as the first treatment in MDC patients (54.5% vs 27.3%; P < .01), and overall radiation use was 84.8% in MDC versus 43.7% in usual care (P < .01).In contrast, surgery as the first treatment was less frequent in MDC patients (33.3% vs 47.5%). Among patients receiving multimodal therapy, those treated in MDC showed a non-significant trend toward shorter TTI (median 31 vs 37.5 days; P = .20) and were less likely to experience treatment delays (16% vs 34.7%; P = .07).

These findings align with evidence from other tumor types, such as breast, rectal, and bone cancers, where multidisciplinary engagement was shown to enhance compliance, referral for complex cases, and changes in management strategy.^3-5 However, the present study did not detect a statistically significant improvement in the timeliness of sarcoma treatment through MDC intervention, a result partly attributed to the relatively small sample receiving MDC care and potential “spillover” benefits of multidisciplinary activities for patients in usual care.¹

References

1. Hollenquest B, Montgomery K, Lucy A, Banks A, Eulo V, Broman K. Effect of a multidisciplinary clinic on time to treatment for soft tissue sarcoma. J Surg Oncol. 2025;132(4):763-772. doi:10.1002/jso.70061
2. Ogura K, Fujiwara T, Healey JH. Patients with an increased time to treatment initiation have a poorer overall survival after definitive surgery for localized high-grade soft-tissue sarcoma in the extremity or trunk: report from the National Cancer Database. Bone Joint J. 2021;103-B(6):1142-1149. doi:10.1302/0301-620x.103b6.bjj-2020-2087.r1
3. Doe S, Petersen S, Buekers T, Swain M. Does a multidisciplinary approach to invasive breast cancer care improve time to treatment and patient compliance? J Natl Med Assoc. 2020;112(3):268-274. doi:10.1016/j.jnma.2020.03.010
4. Kozak VN, Khorana AA, Amarnath S, Glass KE, Kalady MF. Multidisciplinary clinics for colorectal cancer care reduces treatment time. Clin Colorectal Cancer. 2017;16(4):366-371. doi:10.1016/j.clcc.2017.03.020
5. Kurpad R, Kim W, Rathmell WK, et al. A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions? Urol Oncol. 2011;29(4):378-82. doi:10.1016/j.urolonc.2009.04.008