(P 212) REFERENCE SYSTEM OPTIMIZATION, ANALYSES OF THE IMPLEMENTATION OF A PROVINCIAL MULTIDISCIPLINARY SARCOMA NETWORK

Objective: Sarcoma detection is challenging as it requires rapid and efficient investigation combined with adequate referral pattern to specialized centers. As described in a previous study, the time between the first imaging and patient referral constituted around 37% of the total time between the onset of symptoms and the first consultation in a specialized center (mean delay of 66 weeks (median 22)). It was also observed that 60% of patients had to undergo an additional imaging investigation in a sarcoma center, due to insufficient or obsolete imaging. The Réseau Sarcome Québec (RSQ), a provincial network of 3 specialized sarcoma centers, was set up in 2018 to improve sarcoma referral pathways. Since then, new procedures and pre-consultation triage have been established. Personalized teaching letters to referring physicians, consultations over the phone and pre-visit radio-guided biopsies have improved our system efficiency. Continuous professional education is also provided to radiologists by multidisciplinary sarcoma teams. The aim of this study is to present the new modalities implemented since RSQ creation and the results on improvement of patient trajectory.

Methods: This is a retrospective observational study on 1758 patients referred for a suspected musculoskeletal oncologic condition. Patients were categorized as pre (2018-2019) or post (2021-2022) RSQ implemented based on date of referral request. Data was collected from medical records: date of first symptoms, first medical consultation, imaging type and dates, consultation with second-line specialists, previous treatments, type of biopsy and histologic subtypes. Tumors were classified as benign or malignant. Referrals were categorized as: justified in-person appointment, single telephonic consultation, single in-person consultation and unjustified consultation. The impact of the radiologist's collaboration is assessed according to the presence of a specific diagnosis in the referral imaging report and/or a recommendation for referral to a sarcoma center.

Results: Since RSQ creation, the number of consultations increased by 63% (669 to 1089). Single in-person consultations for benign lesions decreased by 50% (32% to 16%). Single telephone consultation for benign tumors increased by 9% and personalized letters returned to referring physicians by 25%. The new procedures have increased the workload of our radiology department as radio-guided biopsies have increased by almost 4 times (75 to 295). Imaging done outside our center revised by our MSK-radiologists and diagnostic imaging requests performed at our center have increased due solely to higher volume of consultation requests. Despite the increase in referrals, time between referrals request received and initial management decreased significantly (36 vs. 23 days, p< 0.001). A positive impact from radiologist’s collaboration was observed. Delay from imaging to referral for patients with a specific diagnosis in imaging report was 3,0 weeks (0-21; 4,9) versus 6,9 weeks (0-40; 8,9) (p=0,003) for those who did not have this information. Mean time for cases where the imaging report suggested referral to a sarcoma center was 3,8 weeks (0-21; 5,0) versus 6,6 (0-40; 9,3) (p=0,268) for those who did not receive this recommendation.

Conclusion: New triage modalities in orthopaedic oncology allows increase overall consultations while reducing inappropriate consultations and preoperative appointment burden. This triage and personalized letters improve awareness and teaching for primary care physicians. However, Increased workload on radiology department and triage management has been observed. Collaboration with referral centers and radiologists improve time to proper referral and reduce the load of imaging resources required in tertiary centers. Incorporating an accurate diagnosis in imaging reports enables doctors and specialists to refer patients more efficiency to specialized sarcoma centers. Clear referral recommendations to a specialized sarcoma center also helps to reduce referral times. Optimizing radiologists' training, both on the sarcoma suspicion and on the importance of referring physicians to the appropriate resources, will significantly improve the sarcoma care pathway.