1. NICE Guidance – Service delivery for patients with Sarcomas
What are the key points?
National Institute of Clinical Excellence

2. What is NICE? How will the guidance work
NICE is a government body that determines the scientific and economic case for adopting a new therapy (it’s called rationing)
It is also involved in preparation and dissemination of guidelines
Service delivery is peer-reviewed so standards will generally be adhered to

3. Background – current sarcoma care in UK
Late diagnosis (average size =10cm)
Uncertainty where to send patients
Lot of centres treating few patients
Variable adherence to protocols
Variable treatment quality

4. Patients want to be more involved…
Identifiable keyworker
More information
Pre- referral (who they will see, tests, times etc)
At referral – written information to take away
Post referral – to be able to mull over things

5. Diagnostic pathway Streamlined
Diagnostic centres – managed by networks in conjunction with comprehensive treatment centres
- lot of options available
All biopsies seen by experienced pathologist
Early radiology review for ‘suspicious’ bones

6. Pathology Ideally no pathologist in isolation
Quality approved (system already in place)
Formal links with others
Training needs
National tissue resource

7. Multidisciplinary Team (MDT)
All sarcoma patients must be managed by a MDT
Minimum workload 100 new STS / yr, 50 new primary bone (or 100 bone)
Why ? Critical mass needed for experience

8. Core members 2 of everything (Surg/path/radiol/oncol) Keyworker
MDT co-ordinator + secretary

9. Extended members Paediatric Oncology Plastics / Chest / GI / ENT
Physiotherapy
Palliative care

10. Process Meet weekly Discuss and document all new cases
Diagnostic + treatment facilities
Data / Trials / Audit (national) /Information etc

11. Who can give CT + RT? Nominated units Participate in trials
Age related facilities
Experience with sarcomas

12. Rehab + Follow up
Involve patients
Keyworker responsible for liasing

13. Audit etc National audit (? Amp rate, LR rate etc)
Minimum data set mandatory
Research incl tissue storage essential
Training for all needed

14. Advantages Clear patient pathway Treated by experienced MDT
Data collection and audit
Research
Better outcomes?

15. Summary Rapid referral to diagnostic centre and on to treatment centre
Treatment centres agree and adhere to protocols, trials etc
Less people treat more patients
? Improved outcomes !