1. Impact of 2019 Sarcoma Service specification for Bristol
Gareth Ayre
SWAG Sarcoma SSG
12th Feb, 2019

2. Rationale for new service spec
Variation in how SAGs function – lack of robust referral / treatment pathways and their oversight. Some patients may not get the most appropriate treatment from the most appropriate team.
National Cancer Registration and Analysis Service (NCRAS) shows that only 40-60% of suspected or confirmed sarcoma is going through a sarcoma MDT (although 95% go through an MDT – e.g. Gynae / breast)

3. Principle aims of latest service spec
Roles and responsibilities of SAGs, SSCs and LSUs have been clarified – especially the role of the SAG in determining referral and treatment pathways for all sarcomas.
All patients with a sarcoma diagnosis are referred to the sarcoma MDT – number of MDT discussions needs to increase
Set (Enforce?) quality metrics for sarcoma services – including recommended case quotas

4. Service model
2.2 - All people with a suspected or confirmed diagnosis of sarcoma must be referred to the Specialist Sarcoma Centre for review by the sarcoma MDT
Implies all GIST, skin, breast, gynae sarcomas must also come through our meeting
Mechanism to capture these cases?
2.2 – Treatment and follow up outside of the SSC must be in line with pathways and protocols agreed by the SAG
We have these pathways agreed already but are not always following them
2.2.3 – LSUs and SSCs must ensure that services available at each designated LSU, together with details of designated practitioners in each Unit, are published on service websites with information about pathways.
Ensure all designated practioners are listed

5. Service model
Sarcoma MDTs will ensure up to date information about their shared pathways, activity and Service User outcomes, including information on site-specific sarcomas is publically available.
Can SCR provide us with sufficient detail for this?
Update website with annual activity report?
2.3.4 – define FU guidelines and when it can be undertaken in LSUs
After treatment, people should be provided with an education and support event, such as a Health and Wellbeing Clinic
2.3.4 – All patients should receive a treatment summary
System in place for RT. Chemo – erratic. Surgery?
Advanced communication training – all core MDT members must attend

6. Treatment delivery
2.2 A soft tissue sarcoma MDT should manage the care of at least 100 new cases of soft tissue sarcoma per year.
2.4 Unplanned excisions - inadvertent or unplanned biopsies/excision, will be the subject of on-going audit and results disseminated within the Network
Mechanism to do this required. Field in SCR?
2.4.5 Intra-abdominal including retroperitoneal sarcoma
Recommended caseload of 24/year
Ability for multi-organ resection
Ancillary surgeons (e.g. LGI, vascular, HPB, UGI) require designation
Contact nearby STS SAGs to detail our RPS service – bolster numbers
Consider regular audit of outcomes

7. Treatment delivery 2.4.6 Gastro-intestinal stromal tumours
Recommended annual new case load of 24 / annum
People with GIST must have their care plan confirmed by a Sarcoma MDT and treatment delivered by services designated by the SAG
Update designated surgeons.
Confirm treatment decisions prospectively
2.4.7 Breast - Surgery may be appropriately undertaken within breast cancer services after discussion has occurred with a sarcoma MDT
2.4.8 Skin - People with skin sarcomas must have their care plan confirmed by a sarcoma MDT

8. Treatment delivery 2.4.9 Chest wall and lung sarcoma
Bone sarcoma centres must have clear pathways defining access to thoracic surgery. The SAG must designate no more than one thoracic surgery centre to link to a sarcoma MDT.
Metastatectomy and ablation must be undertaken in centres with sufficient caseload volume to ensure at least one case per month
2.5 Children / TYA
Paeds representation on SAG – Helen Rees?
Agree locally-defined care pathways inc referral arrangements and communication
Discussion at sarcoma MDT required for non-RMS + extremity tumours
Operational policy defining working arrangement with TYA MDT

9. And finally
4.3 Commissioned providers are required to participate in annual quality assurance and collect and submit data to support the assessment of compliance with the service specification as set out in Schedule 4A-C.