Assessing and investigating children with suspected soft tissue sarcomas: an e-Delphi consensus process

The clinical presentation of childhood soft tissue sarcoma (STS) creates a diagnostic challenge; however, time to diagnosis is significantly associated with survival. This Delphi consensus process aims to contribute to the development of clinical guidelines for healthcare professionals (HCPs) assessing children and young people presenting with signs/symptoms suggestive of STS.

Invitation emails were sent to HCPs to join the Delphi panel. 48 statements were derived from an evidence review by a multidisciplinary team. Participants ranked their level of agreement with each statement on a 9-point Likert scale (1=strongly agree, 9=strongly disagree), with responses ≥7 indicating agreement. Statements not reaching consensus were rewritten and reissued in a subsequent round.

In round 1 (R1), 87/117 (74%) participants responded and 68/87 (78%) completed round 2 (R2).In R1, 47/48 (98%) statements achieved consensus, with 16/48 (33%) gaining more than 90% consensus. One statement did not reach consensus, with 26/87 (29%) scoring <7. All statements reached numerical consensus at the end of R2.There was strong consensus for urgent referral and investigations in cases with strong clinical suspicion, urgent discussion with secondary care if clinical uncertainty exists, increasing HCP education and institutional support to overcome potential barriers to timely diagnosis. Dissent was due to logistical and systematic barriers and a concern for misinterpretation if intended setting is not clearly specified.

These statements will be included in a clinical guideline for suspected STS for use in both primary and secondary care and translated into public awareness tools as part of the Child Cancer Smart national awareness campaign.