In the complex world of oncological treatment, the fragmentation of care—where patients receive medical interventions across multiple healthcare facilities—presents a nuanced paradox. Particularly in the context of retroperitoneal sarcoma, a rare and aggressive form of cancer originating in the retroperitoneal space, this pattern of care delivery raises critical questions about its influence on patient outcomes. A recent comprehensive analysis conducted by researchers at the Fox Chase Cancer Center sheds light on how fragmented care impacts the trajectory of treatment and survival in retroperitoneal sarcoma patients.
Retroperitoneal sarcoma accounts for less than one percent of adult cancers, posing significant challenges not only because of its rarity but also due to its anatomical complexity. High-volume cancer centers—defined by performing more than thirteen surgeries for this malignancy annually—have been correlated with improved patient prognoses. However, in the United States, fewer than ten such high-volume centers exist, imposing logistical and systemic barriers for patients seeking specialized care. This scarcity often necessitates cross-institutional referrals and treatments, leading to fragmented care.
The Fox Chase study meticulously examined data extracted from the National Cancer Database involving 4,976 patients diagnosed and surgically treated for retroperitoneal sarcoma over sixteen years, spanning from 2004 to 2020. This large-scale retrospective cohort study aimed to quantify and contrast the outcomes of patients receiving continuous care within a single institution against those whose treatment was fragmented across multiple facilities. Key metrics analyzed included travel distance to treatment centers, time intervals between diagnosis and the onset of treatment, and overall survival rates.
Findings from the study revealed that patients undergoing fragmented care traveled substantially greater distances to receive treatment, averaging 36 miles compared to 13 miles for those treated at a single institution. This increased travel burden underscores the logistical and financial challenges faced by these patients, which can influence adherence to treatment schedules and quality of life. Moreover, fragmented care patients experienced longer diagnostic-to-treatment delays, with an average interval of 43 days versus 16 days for nonfragmented care recipients, raising concerns about potential risks associated with delayed interventions in aggressive cancers.
Despite these disparities in access and timeliness, a surprising outcome emerged: overall survival rates were statistically equivalent between the fragmented and nonfragmented care groups. This counterintuitive result suggests that although fragmented care introduces certain logistical hurdles, it does not necessarily compromise the ultimate effectiveness of sarcoma management. The implication is profound, indicating that high-quality, multidisciplinary care can be maintained across institutional boundaries without sacrificing survival outcomes.
Dr. Denise Wong, Complex General Surgical Oncology Fellow at Fox Chase and the study’s primary author, emphasizes the need for a patient-centered approach when considering referrals and treatment strategies for retroperitoneal sarcoma. She notes, “The decision to refer a patient to another facility must be carefully evaluated in terms of the patient’s resources and capabilities, including transportation and lodging, as well as continuity of care, especially if neoadjuvant therapies are involved.” This perspective highlights the intricate balance between achieving optimal clinical results and addressing the socioeconomic realities that patients face.
The multidisciplinary nature of sarcoma treatment—which may involve surgery, chemotherapy, radiation, and complex follow-up regimens—magnifies the challenges posed by fragmented care. Coordination between surgical oncologists, medical oncologists, radiologists, and nursing teams becomes crucial to ensuring that care fragmentation does not lead to discontinuities or gaps in treatment protocols. As Dr. Wong cautions, “Effective communication and collaboration across institutions are imperative to mitigate potential negative impacts on the continuity and quality of care.”
Senior author Dr. Anthony Villano from the Department of Surgery at Fox Chase Cancer Center elaborates on the clinical significance of these findings. He emphasizes that while high-volume centers exhibit expertise and resources that are generally associated with improved outcomes, the geographical limitations and scarce availability necessitate pragmatic solutions. The study’s results advocate for flexible, patient-tailored care models that do not rigidly require remaining at a single high-volume center but rather prioritize comprehensive care coordination.
This research also challenges the prevailing assumption that care centralization is universally beneficial for rare cancers like retroperitoneal sarcoma. Instead, it suggests a paradigm where the nuances of each patient’s circumstances—including their physical, emotional, and logistical capacities—must guide treatment planning. Particularly for conditions where timely surgery is balanced against the potential need for adjunctive treatments, understanding how fragmented care dynamics affect timelines is essential.
The longer diagnostic-to-treatment intervals observed in fragmented care might initially seem concerning given the aggressive nature of some sarcomas. However, the equivalency in survival outcomes indicates possible compensatory mechanisms, such as more specialized care or tailored treatment plans at referral centers, which balance out these delays. These findings compel oncologists and healthcare systems to devise strategies that streamline referral processes and minimize avoidable delays while acknowledging the real-world constraints patients encounter.
Beyond the clinical implications, the study underscores the broader health policy challenge of ensuring equitable access to specialized cancer care. The limited number of high-volume centers highlights systemic disparities, and fragmented care patterns may reflect the underlying geographic and socioeconomic inequities in healthcare delivery. Addressing these disparities will require coordinated efforts spanning infrastructure improvements, patient support services, and innovative care delivery models including telemedicine and integrated care networks.
In sum, the Fox Chase Cancer Center’s investigation presents a sophisticated understanding of fragmented care in retroperitoneal sarcoma, illustrating that while such care arrangements are associated with longer travel and delay metrics, they do not inherently diminish survival outcomes. The study compels a shift toward individualized, multidisciplinary, and patient-centered approaches, factoring in real-world exigencies while striving to optimize clinical effectiveness. As cancer care continues to evolve, these insights illuminate pathways to balancing specialization with accessibility, ultimately enhancing the holistic care of patients with rare malignancies.
Subject of Research: People
Article Title: Impact of fragmented care on retroperitoneal sarcomas
News Publication Date: 26-Mar-2025
Web References: http://dx.doi.org/10.1016/j.amjsurg.2025.116319
References: “Impact of Fragmented Care on Retroperitoneal Sarcomas,” The American Journal of Surgery, 2025
Keywords: Sarcoma, Health care delivery
