57.
ALARM SYMPTOMS OF SOFT TISSUE AND BONE SARCOMA
AMONG PATIENTS REFERRED TO A SPECIALIST CENTRE
Heidi Buvarp Dyrop, Peter Vedsted, Katja Maretty-Nielsen, Bjarne Hauge
Hansen, Peter Holmberg Jørgensen, Johnny Keller
Department of Experimental Clinical Oncology Aarhus University Hospital;
The Research Unit for General Practice, Aarhus University; Department of
Experimental Clinical Oncology, Aarhus University Hospital; Department of
Orthopaedics, Sarcoma Centre of Aarhus University Hospital; Department of
Orthopaedics, Sarcoma Centre of Aarhus University Hospital; Department of
Orthopaedics, Sarcoma Centre of Aarhus University Hospital
Background:
Clinical symptoms are important in the diagnosis of sarcoma. In
the Cancer Patient Pathways implemented in Denmark, a set of alarm
symptoms indicative of sarcoma have been defined as criteria for referral to a
sarcoma centre. This initiative may exclude cancer patients without symptoms.
Purpose / Aim of Study:
To investigate symptoms at time of referral among
patients referred to the Aarhus Sarcoma Centre, and examine whether defined
alarm symptoms were seen among sarcoma patients.
Materials and Methods:
An observational population-based study. Medical
records of all patients (n=1126) referred with suspected sarcoma from other
hospitals to the Aarhus Sarcoma Centre in the period 2007-10 were reviewed
for data on symptoms, clinical findings and diagnosis. The defined alarm
symptoms were analyzed for predictive values in diagnosing sarcoma.
Findings / Results:
A total of 258 sarcomas were diagnosed (22,9 %).Of
these, 179 patients (69,4 %) were referred with one or more of the alarm
symptoms. Symptoms with the highest sensitivity and positive predictive value
(
PPV) were “size over 5 cm” for soft tissue tumours, and “deep persisting bone
pains” for bone tumours. Presence of more than one symptom did not increase
the sensitivity or PPV. 79 of the 258 sarcoma patients were not referred due to
defined alarm symptoms. 7 were found accidentally on imaging, 5 were
referred with suspected recurrence of a previously treated sarcoma, 64 were
referred with a confirmed histological sarcoma diagnosis, and 3 did not have
any alarm symptoms and were not referred for the above reasons. The
proportion of sarcoma patients did not change over the years.
Conclusions:
Only 2/3 of referred sarcoma patients were referred due to well
defined alarm symptoms, whereas most of the remaining were found
accidentally. Further studies on presenting symptoms in primary care are
needed.
