Why Sarcoma Diagnosis Often Takes Time, and Why Specialist Access Matters: Alexander Spira, MD, PhD, FACP, FASCO

In this interview with the American Journal of Managed Care® (AJMC®), Alexander Spira, MD, PhD, FACP, FASCO, medical oncologist at Virginia Cancer Specialists and chief scientific officer of NEXT Oncology, discusses why sarcoma is often slow to get diagnosed and explains the importance of connecting patients with physicians who specialize in managing the disease.

Spira notes that delayed sarcoma diagnoses are not typically the result of physician error but rather just due to the nature of the condition. Because sarcomas arise in muscle and soft tissue, early symptoms can resemble a common strain or minor injury, leading patients to be reassured or treated conservatively until the mass fails to resolve. By the time sarcoma is identified, Spira says, tumors can already be substantial, recalling cases presenting as large as 22 centimeters.

Compounding this diagnostic delay is a shortage of physicians who sub-specialize in sarcoma. Spira explains that while many oncologists in community settings can manage sarcoma effectively, certain subtypes present unique challenges, and it is rare even for high-volume specialists to encounter every variant. He stresses the value of maintaining contacts at academic and specialty centers, so community physicians have somewhere to turn when faced with an unusually rare presentation.

At the same time, he notes that not every patient has practical access to an academic medical center, underscoring why collaboration between community oncologists and academic specialists matters. Rather than transferring patients away from local care entirely, he advocates for a model in which both settings work together, allowing most patients to be treated close to home while still benefiting from specialist input when needed.

Spira's comments reflect a broader theme in oncology care delivery of including the academic-community dyad model to reduce treatment delays and expand access to expert guidance without requiring patients to relocate their care entirely. As Spira puts it, balancing these two halves of the care system is "a yin and a yang."

For managed care stakeholders, Spira's remarks point to practical considerations around referral pathways and care coordination for a rare cancer in which timely access to subspecialty expertise, even through informal physician-to-physician consultation, can meaningfully affect how quickly patients are diagnosed and appropriately treated.