Who Are You Going to Let Operate on Your Sarcoma Tumor? — a Disturbingly Ambiguous Finding from the University of California at Davis — which Serves as an Example of How the United States’ Lackadaisical Approach to Collecting Medical Data Causes Decision Problems for Patients

12 July 2013

Citation — to the study that this essay begins with

Robert J. Canter, Caitlin A. Smith, Steve R. Martinez, James E. Goodnight Jr., Richard J. Bold, and David H. Wisner, Extremity soft tissue tumor surgery by surgical specialty: A comparison of case volume among oncology and non-oncology-designated surgeons, Journal of Surgical Oncology, DOI: 10.1002/jso.23372 (early online publication, 03 July 2013)

Even if you are a knowledgeable medical patient —

This finding from the University of California at Davis may raise your eyebrows:

Orthopedic oncologists and surgical oncologists, who have been trained in the complex procedures required to remove sarcomas located deep in the muscles and other soft tissues of the limbs, conducted only 52 percent of these operations at 85 academic medical centers during a three year period . . . .

The remaining 48 percent of these sarcoma surgeries were conducted by general surgeons, plastic surgeons and orthopedic surgeons, whose post-medical degree fellowship training did not emphasize the multi-disciplinary evaluation and surgical management of sarcomas and other cancers located deep in the soft tissue of the arms and legs . . . .

The research team synopsized its results more starkly:

Nearly 50% of deep and malignant ESTT [extremity soft tissue tumor] resections are performed by non-oncology-designated surgeons.

Approximately 17% are performed by practitioners who complete an average of one to two of these procedures per year.

These findings may have significant implications for quality of care in soft tissue tumor surgery.

© 2013 Robert J. Canter, Caitlin A. Smith, Steve R. Martinez, James E. Goodnight Jr., Richard J. Bold, and David H. Wisner, Extremity soft tissue tumor surgery by surgical specialty: A comparison of case volume among oncology and non-oncology-designated surgeons, Journal of Surgical Oncology, DOI: 10.1002/jso.23372 (early online publication, 03 July 2013) (at Abstract)

What is a sarcoma?

A sarcoma is a “cancer” of the body’s connective tissue, including:

bone, cartilage, fat, muscle, vascular, or hematopoietic . . . .

This is in contrast to a malignant tumor originating from epithelial cells, which are termed carcinoma.

Human sarcomas are quite rare.

Common malignancies, such as breast, colon, and lung cancer, are almost always carcinoma.

The UC Davis study was about soft tissue sarcomas that were located in patients’ arms and legs.

The National Cancer Institute explains that:

Adult soft tissue sarcoma is a disease in which malignant (cancer) cells form in the soft tissues of the body.

The soft tissues of the body include the muscles, tendons (bands of fiber that connect muscles to bones), fat, blood vessels, lymph vessels, nerves, and tissues around joints. Adult soft tissue sarcomas can form almost anywhere in the body, but are most common in the head, neck, arms, legs, trunk, and abdomen.

There are many types of soft tissue sarcoma. The cells of each type of sarcoma look different under a microscope, based on the type of soft tissue in which the cancer began.

What treatments for sarcomas are there?

From Wikipedia — which often gives more concisely accurate overviews of complicated phenomena, without unnecessarily dumbing the explanation down:

Surgery is important in the treatment of most sarcomas.^[3]

Limb sparing surgery, as opposed to amputation, can now be used to save the limbs of patients in at least 90% of extremity tumor cases.^[3]

Additional treatments, including chemotherapy and radiation therapy, may be administered before and/or after surgery.^[1]

Chemotherapy significantly improves the prognosis for many sarcoma patients, especially those with bone sarcomas.^[4]

Treatment can be a long and arduous process, lasting about a year for many patients.^[1]

Why do we care who should operate on sarcomas?

Sarcomas affect only about 15,000 new patients a year in the United States, where they account for an estimated 1 percent of all “cancer” cases.

This means that surgeons and oncologists see few, if any cases in their individual practices.

Presumably, if one has is not trained and practiced in dealing with this comparatively rare form of tumor, one may render less than optimal patient outcomes.

And that brings us to the major point of this essay.

We cannot know whether the UC Davis finding means anything

The United States does not collect the necessary data:

Because the database does not include information about clinical outcomes, Canter and his colleagues were unable to associate each surgical specialty to a rate of postsurgical complications or post-surgical survival.

Evidence-based medicine means virtually nothing in the United States because —

Unlike much of Western Europe, the American medical infrastructure makes almost no effort to record medical treatments and follow their outcomes.

A profound irony — or stupidity

The American public seems not to care about its privacy and human rights — when Government tracks its communications, imprisons some people at will and without trial, and even murders some Americans abroad — all in the name of preventing terrorist attacks.

Yet, apparently based on privacy and capitalistic grounds, we do not care that the FDA:

(i) licenses medical devices for which there is no proof of worth or non-harm

(ii) has an insanely porous way of tracking pharmaceutical information

and

(iii) makes almost no effort to find out which medical treatments and techniques work — and which do not — by following patient outcomes.

From the perspective of personal risk, falling victim to bogus, unproven, or incompetent medical treatment is orders of magnitude higher than falling victim to a terrorist attack.

The moral? — We are often astonishingly incompetent in being able to discriminate among the occurrence likelihood of personal risks — and our social and medical infrastructures demonstrate it

American culture is so complacent that it does not even think to collect the data necessary to prove that someone trained and experienced in treating sarcomas is more likely to help patients than someone who is not.

What kind of an evidence-based medical system is that?

When we see institutions veering far from common sense, we have to recognize that something else is steering them there.

If we discovered what works and what does not in medicine, a significant number of people and entities would have to leave the medical market. From their perspective, what’s a few dead, maimed, or sub-optimally assisted patients compared to continued profit?

PeteFree.com

Who Are You Going to Let Operate on Your Sarcoma Tumor? — a Disturbingly Ambiguous Finding from the University of California at Davis — which Serves as an Example of How the United States’ Lackadaisical Approach to Collecting Medical Data Causes Decision Problems for Patients