Sarcomas, rare and with lower survival rates than common tumors, offer insights into healthcare efficiency via the analysis of the total interval of the diagnostic pathway, combining the patient interval (time between the first symptom and visit with a physician) and diagnostic interval (time between first physician visit and histological diagnosis). Switzerland’s healthcare system, Europe’s costliest, lacks research on treating rare conditions, like mesenchymal tumors. This study examines the total interval of the diagnostic pathway for optimization strategies. Analyzing a dataset of 1028 patients presented from 2018 to 2021 to the Swiss Sarcoma Board (MDT/SB-SSN), this retrospective analysis delves into bone sarcoma (BS), soft-tissue sarcoma (STS), and their benign counterparts. Demographic and treatment data were extracted from medical records. The patient interval accounted for the largest proportion of the total interval and secondary care interval for the largest proportion of the diagnostic interval. Age, grade, and localization could be elicited as influencing factors of the length of different components of the total interval. An increasing age and tumor size, as well as the axial localization, could be elicited as factors increasing the probability of sarcoma. The patient and secondary care interval (SCI) offer the greatest potential for optimization, with SCI being the bottleneck of the diagnostic interval. New organizational structures for care work-ups are needed, such as integrated practice units (IPU) as integral part of value-based healthcare (VBHC).
肉瘤作为一种罕见肿瘤，其生存率低于常见肿瘤。通过分析诊断路径总时长——即患者间隔期（从首发症状出现至首次就诊的时间）与诊断间隔期（从首次就诊至获得组织学诊断的时间）之和，可为医疗系统效率评估提供重要参考。瑞士拥有欧洲成本最高的医疗体系，但在间叶源性肿瘤等罕见疾病诊疗领域尚缺乏深入研究。本研究旨在通过剖析诊断路径总时长，探索优化策略。 本研究对2018年至2021年间提交至瑞士肉瘤委员会（MDT/SB-SSN）的1028例患者数据进行回顾性分析，涵盖骨肉瘤、软组织肉瘤及其良性对应病变。研究从医疗记录中提取人口统计学特征与治疗数据。结果显示：患者间隔期在总时长中占比最高，而二级诊疗间隔期在诊断间隔期中占比最大。年龄、肿瘤分级及部位是影响总时长各组成部分的重要因素。高龄、较大肿瘤体积及中轴部位是增加肉瘤发生概率的相关因素。 研究指出患者间隔期与二级诊疗间隔期具有最大优化潜力，其中二级诊疗间隔期是诊断流程的瓶颈环节。亟需建立新型诊疗组织结构，例如将整合实践单元作为价值医疗体系的核心组成部分，以提升诊疗效率。
Enhancing Healthcare for Sarcoma Patients: Lessons from a Diagnostic Pathway Efficiency Analysis
肿瘤(癌症)患者之家