Following the results of an international clinical trial, it was determined that the survival rates of Ewing sarcoma were superior in Germany than those in the UK.
Background of the project:
In England, care for patients with primary bone tumours involves coordinating services from different specialists to deliver surgery, radiotherapy, chemotherapy and support after treatment. There are five nationally commissioned centres for surgery, but other aspects of care are routinely delivered by other centres and specialists.
Results form an international clinical trial that evaluated chemotherapy options for Ewing sarcoma patients, identified survival differences between patients treated in Germany compared to those treated in the UK (5yr overall survival 66.5% vs. 54.3%). It was proposed that the more centralised decision-making processes demonstrated in Germany could lead to better outcomes.
A National Multidisciplinary Team for Ewing’s Sarcoma (NEMDT) was established in 2011, to address variations in primary tumour control which might underlie this survival disparity and to ensure uniform patient care across the UK. The NEMDT is a unique national forum set-up to improve the treatment planning and choices made for Ewing sarcoma patients and includes orthopaedic surgeons, clinical and medical oncologists with recognised expertise in treating ES.
Results of the study:
Dr Jessica Bates, a paediatric oncologist based at University College London Hospital was appointed to review and analyse the available information from the NEMDT meetings with the objective of defining best practices for therapy for Ewing sarcoma. Dr Bate also organized the 2nd International Consensus Meeting on Local Therapy in Ewing Sarcoma during this project.The meeting had representation from clinicians across the globe, coming together to discuss past cases and come to a consensus on a number of issues surrounding local treatment for Ewing sarcoma patients, including the use of radiotherapy and proton therapy.
Summary of the recommendations arising from the NEMDT fellowship evaluation:
- NEMDT information is difficult to search, therefore, a database collecting detailed information on outcome, primary tumour site and treatment, as well as treatment decision delays, will facilitate the extraction of information.
- In addition, the database should also include information from the National Proton Registry, to identify whether NEMDT recommendations influence proton beam therapy panel decisions.
- All bone sarcoma Multi-Disciplinary Team coordinators should be made aware of the NEMDT and its referral process, to highlight potential new patients being discussed.
- The membership of the NEMDT should be extended to include a consultant radiologist to present key images for discussion of local control and a sarcoma nurse specialist/patient advocate.
- The NEMDT should develop its educational role and act as a forum for discussion of new local treatments for patients with ES. Patient views should be presented by someone who has met them, such as a specialist nurse. And finally, MDT recommendations should be provided to patients in plain English and tools to improve patient choice and enhance communication should be implemented.
Dr Jessica Bate, a paediatric oncologist based at University Hospital Southampton, was supported by The Ewing Sarcoma Research Trust and the Bone Cancer Research Trust to carry out this project. Dr Bate completed this fellowship while incorporating the voices of patient and carers to form a valuable advisory panel. Read more about this advisory panel meeting here.