Second opinions at multidisciplinary centers

Many people with sarcoma could live longer and better lives if they saw a sarcoma specialist sooner. That’s why the Sarcoma Alliance lists multidisciplinary sarcoma centers and gives grants to those who have to travel to get a second opinion.

Travel is common because more than half the states in America lack a multidisciplinary sarcoma center that treats adolescents and adults. Parents may need to travel to get their younger children seen, and they also can apply for grants, but they have more options.

“My feeling is that any pediatric hospital is suitable for the three common pediatric sarcomas: rhabdomyosarcoma, osteosarcoma and Ewing,” says Alliance President Joan Darling, a volunteer with the Children’s Oncology Group, which has a map of its member hospitals.

Because there is no official designation or board certification for a “sarcoma specialist,” people may define it differently. In 2004, the National Cancer Institute convened the Sarcoma Progress Review Group, which recommended patients be treated at multidisciplinary sarcoma centers, and it listed criteria for the centers. Here is the Alliance’s updated version:
• A sarcoma medical group consisting of all specialties, including surgical, orthopedic and medical oncologists; radiologists; pathologists; and oncology nursing as well as rehabilitation services.
• At least one group member who belongs to a sarcoma-oriented medical organization, such as the Connective Tissue Oncology Society (CTOS).
• Publications concerning sarcoma in peer-reviewed journals.
• Sarcoma conferences (e.g. Tumor Board), where sarcoma group members meet at least once per month to discuss patient care issues.
• At least 100 sarcoma patients seen per year.
• MRI imaging available; PET scans desired.
• Patient enrollment in clinical trials.
• Strong support personnel such as social workers, psychologists and psychiatrists.
• Sarcoma support group desired.

“Since there are approximately 50 types of sarcoma, accurate diagnosis by a world-class pathologist is the first step in an optimal treatment plan. Surgery, radiation therapy and chemotherapy are all critical approaches toward treatment of the primary tumor, prevention of tumor spread, and therapy of sarcoma even after it has spread to other sites. Radiologists are key to diagnosis, recurrence, and assessment of response to therapy. Rare diseases such as sarcoma are best managed by an experienced multidisciplinary team at a comprehensive cancer center such as The Sylvester Cancer Center in Miami,” says Jonathan Trent, MD, PhD, a sarcoma medical oncologist who recently moved to Miami from the M.D. Anderson Cancer Center in Houston.

CTOS and the Musculoskeletal Tumor Society will hold a joint annual meeting this week, Oct. 26-29, in Chicago. Dr. Trent will present research there. The meeting will draw hundreds of sarcoma experts from around the world, along with volunteers from the Sarcoma Alliance and staff from other nonprofits. Ironically, Illinois does not have a multidisciplinary sarcoma center, according to Alliance criteria. But the Chicago area does have sarcoma doctors who participate in clinical trials.

Across the country, many patients fail to get state-of-the-art care. They may not know that sarcoma specialists and multidisciplinary centers exist. Or, they may lack the desire, time or money to travel to one, the Progress Review Group report says.

“Additionally, physicians and surgeons in small- and moderate-sized hospitals often want to maintain control of patients … for economic and other reasons,” the report says. “However, many physicians do not appreciate how complex the care of sarcoma patients has become and are not aware of the many alternative care strategies available.”

Especially with a rare cancer, most doctors will not mind if a patient seeks a second opinion. It's a bad sign if a physician is offended. Sarcoma centers allow patients to schedule appointments without a referral from their current physicians, although some insurance plans may require a referral for reimbursement. Sarcoma centers often can help patients with insurance questions, as well as travel plans.

After getting a second opinion, some patients may choose to get part or all of their treatment closer to home, with a doctor in the sarcoma center consulting with the local doctor. If nothing else, a second opinion may reassure patients that they are getting the best treatment available.