French Guidelines (SOR): Any Impact Since 1995?

1. French Guidelines (SOR): Any Impact Since 1995? BN Bui Institut Bergonié, Bordeaux FSG CETOS 2005

2. 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)

3. 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

4. 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

5. ONCORA Study Viscera - inner trunkal region 38 Extremities 36 Abdominal wall 19 Head & Neck 7 • Patient characteristics • Anatomic location of the tumor: (n=100) • Clinical management • Organizing physician:medical oncologist 61% pts: 80% post-biopsy • Healthcare network:67%, only 50% post-biopsy • pre-biopsy multidisciplinary cooperation: 7% • Initial biopsy: 42% • histological diagnosis at biopsy: 93% • deviation at biopsy: 65% • Initial staging: 82% Ray-Coquard, Ann oncol, 2004; 15: 307-15

6. ONCORA Study Multidisciplinary cooperation before biopsy 7% 39% before biopsy before surgery before complementary treatment 73% before 2nd line surgery 75% • Multidisciplinary cooperation • before biopsy 7% • before 1st line surgery 39% • before 2nd line surgery 67% • before other treatments 73% • Agreement with SOR • initial evaluation 57% • biopsy 35% • 1st line surgery 52% • 2nd line surgery 70% • radiation therapy 81% • chemotherapy 94% • follow-up 74% • Total agreement: 35% Ray-Coquard, Ann oncol, 2004; 15: 307-15

7. Local relapse / multidisciplinary cooperation Rar-Coquard zt al.,, 2005

8. metastatic relapse / multidisciplinary cooperation Rar-Coquardet al., 2005

9. 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

11. 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