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Health Services and Patient-Centered Outcomes Research

(P 204) ANALYSIS OF QUALITY INDICATORS OF SOFT TISSUE SARCOMA TREATMENT WITH CANCER REGISTRY DATA IN GERMANY 2015-2021

    Author(s)

  • Jens Jakob, MD (he/him/his)

    Consultant Sarcoma Surgeon
    Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

    • Co-Author(s)

  • FG

    Frank Goßmann, n/a

    Bavarian Cancer Registry, Regional Center Würzburg, Bavarian Health and Food Safety Authority, Würzburg, Germany
    Würzburg, Bayern, Germany

  • Franka Menge, MD

    Dr.
    Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

  • Bernd Kasper, MD, PhD (he/him/his)

    Medical Director Mannheim Cancer Center (MCC)
    Mannheim University Medical Center, University of Heidelberg
    Mannheim, Baden-Wurttemberg, Germany

  • NB

    Nikola Beck, n/a

    Bavarian Cancer Registry, Regional Center Würzburg, Bavarian Health and Food Safety Authority, Würzburg, Germany
    Würzburg, Baden-Wurttemberg, Germany

  • Christoph K. W. Deinzer, MD (he/him/his)

    Deputy Head of Medical Oncology
    Department of Internal Medicine VIII - Medical Oncology and Pneumology, University Hospital Tübingen and Center for Soft Tissue Sarcomas, GIST and Bone Tumors (ZWS) of the University Hospital Tübingen and of the Comprehensive Cancer Center (CCC) Tübingen-Stuttgart, Tübingen, Germany
    Tübingen, Baden-Wurttemberg, Germany

  • BF

    Bianca Franke, n/a

    Association of German Tumor Centers, ADT
    Berlin, Berlin, Germany

  • AH

    Anne Hendricks, MD

    Sarcoma Center Würzburg,University Hospital of Würzburg
    Würzburg, Bayern, Germany

  • MK

    Monika Klinkhammer-Schalke, PhD

    aBavarian Cancer Registry, Regional Center Würzburg, Bavarian Health and Food Safety Authority
    Regensburg, Bayern, Germany

  • MS

    Manije Sabeth-Rashedi, MD

    German Cancer Society
    Berlin, Berlin, Germany

  • MU

    Martin Utzig, MD

    German Cancer Society
    Berlin, Berlin, Germany

  • Peter Hohenberger, MD (he/him/his)

    Prof.
    Mannheim University Medical Center
    Mannheim, Baden-Wurttemberg, Germany

  • SZ

    Sylke Zeissig, PhD

    Bavarian Cancer Registry, Regional Center Würzburg, Bavarian Health and Food Safety Authority
    Würz, Bayern, Germany

Objective: Empirical data show that soft tissue sarcoma (STS) treatment according to clinical guidelines and in sarcoma centers results in a survival benefit for patients. In 2021, the first comprehensive German STS guideline was published including the definition of quality indicators (QIs) of STS treatment. In the same time period, the German Cancer Society established an audit system for certified sarcoma centers in Germany. This article analyses the quality of STS care in Germany prior to the publication of the German STS guideline and before establishing certified sarcoma centers in Germany.

Methods: A comprehensive population-based cohort of 20,936 sarcoma patients diagnosed between 2015 and 2021 was extracted from cancer registry data using ICD-O-3 codes for topography and histological subtype. To identify trends over time, annual percentage changes (APCs) were calculated. The following QIs were suitable and thus selected for comparison: pre-treatment tumor board, R0 resection, hysterectomy without morellation for sarcoma confined to the uterus, anthracycline-based first line systemic treastment (excluding GIST) and postoperative mortality for retroperitoneal sarcomas.

Results: A pre-treatment referral to a tumor board (initial diagnosis of STS)) was documented in 12% of all cases in 20215 and 28% in 2021. The mean R0 resection rate was 82% (81-83%). Hysterectomy without morcellation for sarcoma confined to the uterus were performed in 88% (83-91%). An anthracycline based first-line chemotherapy for STS was chosen in 80% (77%-82%) of all cases. Th postoperative mortality for retroperitoneal sarcomas revealed was 1.4% (0-9.1%) in the years 2015-2021.For comparison, the median fraction of patients discussed in pre-treatment tumor boards and the rate of R0 resections at sarcoma patients treated at one of the 21 certified sarcoma centers in 2023 were 92% and 82%.

Conclusion: The evaluation of cancer registry data with regard to QIs is representative of the population as a whole. The possibility of filtering the data according to localization and ICD-O coding is a strength; limitations may lie in the completeness and correctness of the data. In the coming years, we expect that data from the cancer registries can also be used on a site-specific basis and thus as a benchmark for the certified sarcoma centers.