Abstract
Most lumps found in the extremity are benign. Some, however, are not. An approach to tertiary referral is required to accommodate the need for specialist evaluation of all concerning lumps, while maintaining an acceptable time to diagnosis and definitive management. We describe a new approach to tertiary sarcoma service, utilising modern communication technology and the “virtual clinic” approach.
Methods
Data from 1053 consecutive patients referred to the MSK oncology service at Glasgow Royal Infirmary between January 2010 and August 2012 was prospectively collected.
Results
All suspected musculoskeletal sarcoma cases were discussed referred to our tertiary sarcoma virtual clinic were discussed. Mean time from referral to clinic for the 625 patents referred from January 2011 was 5.1 days. 41% of referrals came from out-with our health trust. 28.3% of patients were discharged from the virtual clinic without need for physical appointment. 45.8% were sent for further investigation prior to first clinic appointment, with the remaining 25.5% given an urgent clinic appointment. Final diagnoses of soft tissue tumours, bone tumours and “tumour like conditions” were present in almost equal parts. 358 patients (34%) of patients went on to have surgery, with 59 malignant soft tissue and 53 malignant bone tumours over this time period
Conclusions
Through an early, virtual clinic approach to tertiary sarcoma care, a third of referrals have been managed quickly without the need for an unnecessary appointment for the patient. For a further 45% of patients the first appointment will be after all necessary investigations have been performed to facilitate rapid decision making. This enables shorter clinic waiting times and rapid transition from first referral to definitive management.
