Transcript French Guidelines (SOR): Any Impact Since 1995

French Guidelines (SOR): Any
Impact Since 1995?
BN Bui
Institut Bergonié, Bordeaux
FSG
CETOS 2005
The SOR project
• Initiated in 1994 as an initiative of the French
Federation of Cancer Centers (FNCLCC)
• To produce evidence-based recommendations
for the primary care of cancers.
• Was directed toward board-certified oncologists
• The first SOR for osteosarcoma and adults soft
tissue sarcoma was published in 1995 (book,
CD, FNCLCC and FSG web sites, parts as
articles in médical press)
The regional cancer networks
• Governemental decision in 1996; established
1996-2000
• To allow all cancer patients
– multidisciplinary care
– At local sites with local hospital or clinics cooperating
in « multidisciplinary oncology concertation units »
with local oncologists
– At a central site (cancer center, university hospital)
serving as reference center
ONCOLOR: referral to a regional
multidisciplinary commitee
Retrospective analysis on 118 sarcoma patients seen in
2000 at the reference center
• Osteosarcomas: 6
– Conformity to SOR: 100%
• Soft tissue sarcomas
– 25/34 adequate initial imaging
– Biopsy prior surgery: 16/34
– Multidisciplinary concertation
•
•
•
•
before biopsy: 4/34
Before 1rst surgery:8/34
After 1rst surgery: 20/34 (59%)
After post-op treatment: 2/34
Uwer et al., Bull cancer 2003; 90:269-77
ONCORA Study
• Patient characteristics
– Anatomic location of the tumor: (n=100)
Viscera inner trunkal region
• Clinical management
38
– Organizing physician:
medical oncologist 61% pts: 80% post-biopsy
– Healthcare network:
67%, only 50% post-biopsy
– pre-biopsy multidisciplinary cooperation: 7%
– Initial biopsy: 42%
Extremities
36
Abdominal wall
19
Head & Neck
7
• histological diagnosis at biopsy: 93%
• deviation at biopsy: 65%
– Initial staging: 82%
Ray-Coquard, Ann oncol, 2004; 15: 307-15
ONCORA Study
• Agreement with SOR
–
–
–
–
initial evaluation 57%
biopsy 35%
1st line surgery 52%
2nd line surgery 70%
•
Multidisciplinary cooperation
– before biopsy 7%
– before 1st line surgery 39%
– before 2nd line surgery 67%
– before other treatments 73%
– radiation therapy 81%
– chemotherapy 94%
– follow-up 74%
– Total agreement: 35%
before
biopsy
7%
before
complementary
treatment
73%
39%
before biopsy
before surgery
before
2nd line surgery
75%
Ray-Coquard, Ann oncol, 2004; 15: 307-15
Multidisciplinary
cooperation
Local relapse / multidisciplinary
cooperation
Rar-Coquard zt al.,, 2005
metastatic relapse /
multidisciplinary cooperation
Rar-Coquardet al., 2005
impact of SOR
• So far:
– Poor total conformity to guidelines in STS
– Mainly because of poor conformity at early phases of
patient care
– Good conformity to guidelines once the patient is
discussed in the cancer network
RECOMMANDATIONS POUR LA PRATIQUE CLINIQUE
Standards, Options et Recommandations 2005
pour la prise en charge des patients adultes
atteints de sarcome des tissus mous, de sarcome
utérin ou de tumeur stromale gastro-intestinale
Mise à jour
Validation du document initial : 1995
Validation de la dernière mise à jour : en cours
For a better impact of SOR
• A better diffusion
– Web sites of the regional network
– Simplified « carry-on » paper version
• An appropriate targeting toward surgeons
– More regional information
– Information by pathologists with path. report
• Organize an information for patients
• Prospective, nationwide, evaluation of compliance to
SOR
– Definition of quality of care criterias
– Standardized reports of diagnosis and treatment