Referral delays in sarcoma patients: a prospective cohort study and management guidelines

Sarcoma management includes multidisciplinary treatment in specialized referral centers. Delays in referral and diagnosis of patients can lead to a negative impact on outcomes. This study aimed to determine timelines and factors contributing to referral delays in the sarcoma population. An analysis of a prospective cohort study was undertaken in one a tertiary sarcoma referral center between 2011 and 2020. Chart review and prospective data collection with dedicated questionnaires were collected (N = 713 patients, 455 (64%) low-grade and 258 (36%) high-grade tumors). Delays from first medical consultation to sarcoma center referral were found. Time from first medical consultation to diagnostic imaging was the most important source of delay, representing 49% (high-risk) and 42% (low-risk) of the total delay. Inadequate imaging was common and had to be repeated for 51% of MRI exams and 18% of CT scans. Referral times for most patients were unacceptably long. Sources for inappropriate delays were difficult access to imaging studies for primary care physicians and unnecessary referrals to other specialists. To address these issues, a sarcoma referral network was created. Guidelines for patient evaluation and imaging were published in order to improve patient outcomes and optimize health care resources.