The Danish Cancer Patient Pathway for sarcoma defines a set of alarm symptoms as criteria for referral to a sarcoma center. This may exclude cancer patients without alarm symptoms, so we investigated the presence of alarm symptoms (defined as being indicative of a sarcoma) in patients who had been referred to the Aarhus Sarcoma Center.
We reviewed the medical records of all 1,126 patients who had been referred, with suspected sarcoma, from other hospitals in the period 2007-2010 for information on symptoms, clinical findings, and diagnosis. Alarm symptoms were analyzed for predictive values in diagnosing sarcoma.
179 (69%) of 258 sarcoma patients were referred with alarm symptoms (soft-tissue tumor>5 cm or deep-seated, fast-growing soft-tissue tumor, palpable bone tumor, or deep persisting bone pain). The remaining 79 sarcomas were found accidentally. "Size over 5 cm" for soft-tissue tumors, and "deep persisting bone pain" for bone tumors had the highest sensitivity and positive predictive value. Of the 79 sarcoma patients who were referred without alarm symptoms, 7 were found accidentally on imaging, 5 were referred with suspected recurrence of a sarcoma, 64 were referred with a confirmed histological diagnosis, and 3 were referred for other reasons.
Defined alarm symptoms are predictive of sarcoma, but one-third of the patients were found accidentally. Further studies on presenting symptoms in primary care are needed to assess the true value of alarm symptoms.
Notes
Cites: Mayo Clin Proc. 2007 Nov;82(11):1409-3217976362
Cites: BMJ. 2007 May 19;334(7602):104017493982
Cites: Br J Cancer. 2009 Dec 3;101 Suppl 2:S5-819956163
Cites: Ann R Coll Surg Engl. 2010 Jul;92(5):417-2120487596
Cites: Br J Gen Pract. 2010 Sep;60(578):e366-7720849687
Cites: Ann Surg Oncol. 2012 Mar;19(3):871-721792512
Cites: Health Policy. 2012 Apr;105(1):65-7022136810
Cites: Ann R Coll Surg Engl. 2012 May;94(4):261-622613305
Cites: J Bone Joint Surg Am. 2012 Jul 18;94(14):1291-622810399
Cites: Surgeon. 2012 Aug;10(4):245-622658926
Cites: Fam Pract. 2013 Apr;30(2):153-6023097250
Cites: Health Policy. 2013 Nov;113(1-2):110-724138955
Cites: Ann R Coll Surg Engl. 2001 May;83(3):203-511432141
Cites: Ugeskr Laeger. 2002 Jun 3;164(23):3036-912082855
Cites: Orthopedics. 2004 Feb;27(2):209-1214992389
Cites: J Bone Joint Surg Br. 1990 Sep;72(5):754-62211748
Cites: Br J Surg. 1997 Dec;84(12):1692-69448617
Cites: BMJ. 1998 Jul 11;317(7151):93-49657781
Cites: Ann R Coll Surg Engl. 2005 May;87(3):171-315901376
Cites: Br J Gen Pract. 2009 Jun;59(563):441-5, 447; discussion 44619520027