Leiden University: Michiel van de Sande delivers inaugural lecture on advancing sarcoma care

On 5 November 2021, Professor Michiel van de Sande of the Department of Orthopedics in the Leiden University Medical Centre (LUMC) delivered his inaugural lecture ‘The Art of Doing and Doing Nothing’. Van de Sande used the opportunity to explore both physical and philosophical aspects of co-decision making within sarcoma care.

Van de Sande has been appointed professor, in particular of pediatric orthopedic oncology, as of May 2020. His research concerns inter- and national collaborations aimed at examining different types of sarcomas in joint, bone and soft tissues. According to the Professor: ‘This is a rare type of malignant tumor that represents, for example, only 1% of all cancers in the Netherlands. Thus, I was drawn to the field in search of answers to clinical questions concerning prognosis (the expected course of a medical condition) and treatment options for sarcoma.’

Collaborating to accuracy
Despite its rarity, the number of sarcoma diagnoses are increasing due to our ageing population. ‘In the past two decades, however, patient prognosis has been minimally improved. There are several reasons for this, including the absence of a global patient database’, Van de Sande notes. To tackle this issue, much of his research currently focuses on the potential of multicenter studies: ‘By combining data from care units around the world, not only are we able to base prognosis prediction models on larger patient populations, but the models themselves become more accurate. As a result, we can distill generalized treatment options for the individual patient.’

Physical and philosophical questions
Van de Sande then sketches a scenario within sarcoma care for his spectators, posing several physical and philosophical questions: ‘A multidisciplinary treatment team is fundamental, as it can encompass surgical procedures, chemotherapy, targeted drugs or radiotherapeutic options. For doctors, rational thinking based on prognosis often determines the therapy of choice. But if prognostication is not equally developed amongst doctors at present, what implications does this have during the care process?’ He continues by reflecting on how scientific knowledge serves as guidance for patients but lacks the emotional factor, which he also considers important in the shaping of healthcare. ‘For instance, based on hope, a patient can opt for a completely different treatment – or even for nothing at all – and their response may influence our current statistical model predictions.’

Hope in future healthcare providers
Sharing the decision-making process with patients is, therefore, necessary to find a balance between rational and emotional. ‘Determining medically optimal therapies that are aligned with the individuals wishes and catered to them is where we have much to win. Sometimes this will mean doing and sometimes doing nothing’, says Van de Sande. The Professor concludes by acknowledging future medical workers: ‘Many of my questions will remain unresolved for now, but I have hope and full confidence in your answers of tomorrow for this rare disease.’

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