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Multidisciplinary Care of STS

Insights From: Mark Agulnik, MD, Northwestern University Feinberg School of Medicine;Brian Van Tine, MD, PhD, Washington University
Published: Thursday, Nov 10, 2016


Transcript:

Brian Van Tine, MD PhD:
There are approximately 42 medical oncologists in the United States that focus solely on the treatment of soft tissue sarcoma. Most of these are academic, and I feel that it’s our role to make sure that we can provide up-to-date guidance for how patients should be treated. I don’t think it’s our role to treat everybody. I actually think it’s our role to make sure people are treated correctly. I think this goes back to the NCCN Guidelines, which really state that the planning for a sarcoma patient should come from people who do it all the time, which is a rough translation of what’s really there. What we’ve done in the Midwest is really formed a partnership between the private practice doctors and the sarcoma center at Washington University, where we don’t give standard of care chemotherapy unless they live in St. Louis. I don’t believe it’s in a patient’s best interest to drive 5, 6 hours to get something that they can get locally. But I think coming to a sarcoma center where they’re beginning to put together that marathon of treatments, so you know what to use first and use second and how to intervene in partnership with us, is actually a highly constructive exercise. That’s where I think our role is.

I think the best advice I can give a community physician is to form a partnership with your local sarcoma expert so that you can send the patient. They’ll be more likely to send them back unless they’re doing special treatment, like helping to advance the field through clinical trials. Because still in 2016, the standard of care is still going to remain a clinical trial until we start curing everyone.

Mark Agulnik, MD: At the organization I work at, we have an incredible multidisciplinary team that gets together every second week to discuss all patients that are walking through the door with soft tissue sarcomas. It’s a benefit to me treating these patients. It’s certainly a benefit to the patient, as well as all that are involved in the care. When we talk about a multidisciplinary team, we’re not talking about a physician-based multidisciplinary team. We’re talking hospital-wide, any person that’s going to get into contact with these patients. And so, we’re looking at our surgical oncologists that specialize in sarcomas, we’re looking at our orthopedic oncologists who specialize in sarcomas, we’re looking at radiation oncology, we’re looking at medical oncology, we’re looking at social workers, and we’re looking at the psychosocial oncology. We have a very large adolescent and young adult program because a lot of these patients are going to be under 39 years of age. It’s important to have the pathologist who specializes in soft tissue sarcomas, as well as the radiologist, present for the discussion. Really, it’s a large team, it’s a large group. We get together, and it’s very important for patient care that we make sure that we’ve all seen everything, we’ve all reviewed everything. From a patient standpoint, this is what I would always want.

Brian Van Tine, MD PhD: I think one of the nice things about working in St. Louis is that we’re at the crossroads of America with most of the freeways crossing, and we find that people come a fair distance. And so, when you ask what our patient population is that we see, a good 80% of these patients are patients that are traveling for clinical trials and new agents because they have metastatic disease. Then, if you ask how many patients are coming with locally resectable disease, it’s probably about 20% of what we see. Give or take, we see about 1000 new patients a year. And so, you can see who’s coming in for access to new agents and, at the same time, what really takes very careful multidisciplinary care.

Transcript Edited for Clarity
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Transcript:

Brian Van Tine, MD PhD:
There are approximately 42 medical oncologists in the United States that focus solely on the treatment of soft tissue sarcoma. Most of these are academic, and I feel that it’s our role to make sure that we can provide up-to-date guidance for how patients should be treated. I don’t think it’s our role to treat everybody. I actually think it’s our role to make sure people are treated correctly. I think this goes back to the NCCN Guidelines, which really state that the planning for a sarcoma patient should come from people who do it all the time, which is a rough translation of what’s really there. What we’ve done in the Midwest is really formed a partnership between the private practice doctors and the sarcoma center at Washington University, where we don’t give standard of care chemotherapy unless they live in St. Louis. I don’t believe it’s in a patient’s best interest to drive 5, 6 hours to get something that they can get locally. But I think coming to a sarcoma center where they’re beginning to put together that marathon of treatments, so you know what to use first and use second and how to intervene in partnership with us, is actually a highly constructive exercise. That’s where I think our role is.

I think the best advice I can give a community physician is to form a partnership with your local sarcoma expert so that you can send the patient. They’ll be more likely to send them back unless they’re doing special treatment, like helping to advance the field through clinical trials. Because still in 2016, the standard of care is still going to remain a clinical trial until we start curing everyone.

Mark Agulnik, MD: At the organization I work at, we have an incredible multidisciplinary team that gets together every second week to discuss all patients that are walking through the door with soft tissue sarcomas. It’s a benefit to me treating these patients. It’s certainly a benefit to the patient, as well as all that are involved in the care. When we talk about a multidisciplinary team, we’re not talking about a physician-based multidisciplinary team. We’re talking hospital-wide, any person that’s going to get into contact with these patients. And so, we’re looking at our surgical oncologists that specialize in sarcomas, we’re looking at our orthopedic oncologists who specialize in sarcomas, we’re looking at radiation oncology, we’re looking at medical oncology, we’re looking at social workers, and we’re looking at the psychosocial oncology. We have a very large adolescent and young adult program because a lot of these patients are going to be under 39 years of age. It’s important to have the pathologist who specializes in soft tissue sarcomas, as well as the radiologist, present for the discussion. Really, it’s a large team, it’s a large group. We get together, and it’s very important for patient care that we make sure that we’ve all seen everything, we’ve all reviewed everything. From a patient standpoint, this is what I would always want.

Brian Van Tine, MD PhD: I think one of the nice things about working in St. Louis is that we’re at the crossroads of America with most of the freeways crossing, and we find that people come a fair distance. And so, when you ask what our patient population is that we see, a good 80% of these patients are patients that are traveling for clinical trials and new agents because they have metastatic disease. Then, if you ask how many patients are coming with locally resectable disease, it’s probably about 20% of what we see. Give or take, we see about 1000 new patients a year. And so, you can see who’s coming in for access to new agents and, at the same time, what really takes very careful multidisciplinary care.

Transcript Edited for Clarity
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