Dr Randall on the Importance of Multidisciplinary Efforts in Sarcoma Management

“It really is important that [patients with sarcoma] get to centers where they can get that comprehensive care.”

R. Lor Randall, MD, FACS, the David Linn Endowed Chair for Orthopedic Surgery, chair of the Department of Orthopedic Surgery, and professor in the Department of Orthopedic Surgery at the University of California Davis Health, emphasized ongoing unmet needs in the treatment of patients with sarcoma, emphasizing that suboptimal access to multidisciplinary, coordinated care remains a critical barrier to optimal outcomes.

According to Randall, patients with sarcoma often encounter well-intentioned specialists such as orthopedic oncologists, who are highly skilled within their own discipline but may practice in relative isolation from other key members of the care team. Without integration with medical oncologists, pediatric oncologists, radiation oncologists, and pathologists, patients with sarcoma are at risk for receiving incomplete or fragmented care.

This lack of coordinated expertise can lead to several downstream consequences, including inaccurate or delayed diagnosis, omission of essential systemic therapy, and treatment plans that fail to fully align with evidence-based protocols. Sarcomas, given their rarity and biological diversity, require precise histopathologic classification and staging to guide the optimal sequencing of surgery, systemic therapy, and radiotherapy. An incomplete diagnostic workup or suboptimal treatment sequencing may compromise both local control and long-term survival, Randall explained.

Randall underscored that multidisciplinary sarcoma programs, ideally located at high-volume referral centers, provide the infrastructure needed for comprehensive care delivery. These programs integrate subspecialists into a single care pathway, ensuring that diagnostic imaging and pathology are reviewed by experts familiar with sarcoma-specific nuances, systemic therapy decisions are made in collaboration with experienced medical or pediatric oncologists, and surgical interventions are planned in concert with the full treatment team.

He noted that such coordinated models not only improve diagnostic accuracy and adherence to optimal treatment protocols but also enhance access to clinical trials, which is particularly relevant in sarcoma given the relatively limited number of standard systemic therapy options. In rare tumor types like sarcoma, trial participation may provide access to novel targeted agents, immunotherapy combinations, or advanced radiotherapeutic approaches that would not otherwise be available in community settings.

Ultimately, Randall concluded that improving outcomes for patients with sarcoma requires structural solutions to facilitate timely referral to comprehensive sarcoma centers. Education for community-based providers on referral pathways, increased patient awareness of specialized resources, and health system policies that support multidisciplinary case review are all strategies that can help address the current access gap.