All patients with osteosarcoma and Ewing’s sarcoma should be considered for protocolised pre- and/or postoperative chemotherapy by a medical oncologist with experience in treating sarcoma and involvement in multidisciplinary care (ESMO 2014a). Other forms of bone sarcomas should be treated as per multidisciplinary team discussion.

Rhabdomyosarcoma should be treated with protocolised pre- and/or postoperative chemotherapy by a medical oncologist with experience in treating sarcoma and involvement in multidisciplinary care.

For patients with other forms of localised soft tissue sarcoma, chemotherapy is not the current standard of care, and patients should be treated as per the multidisciplinary team’s treatment plan.

Training, experience and treatment centre characteristics

The following training and experience is required of the appropriate specialist(s):

• Medical oncologists (Fellowship of the Royal Australasian College of Physicians or equivalent) must have adequate training and experience with institutional credentialling and agreed scope of practice within this area (ACSQHC 2004).
• Adequate training must include subspecialty training at a national or international centre of excellence with continued practice as part of a recognised multidisciplinary team.
• Nurses must have specialist training in chemotherapy handling, administration and disposal of cytotoxic waste and advanced understanding of chemotherapy toxicities. They must also have advanced central venous access knowledge and skills.
• Chemotherapy should be prepared by a pharmacist with adequate training in chemotherapy medication, including dosing calculations according to protocols, formulations and/or preparation.
• In a setting where no medical oncologist is locally available, some components of less complex therapies may be delivered by a medical practitioner and/or nurse with training and experience and with credentialling and agreed scope of practice within this area under the guidance of a medical oncologist. This should be in accordance with a detailed treatment plan or agreed protocol and with communication as agreed with the medical oncologist or as clinically required.

Hospital or treatment unit characteristics for providing safe and quality care include:

• a clearly defined path to emergency care and advice after hours
• access to basic haematology and biochemistry testing
• cytotoxic drugs prepared in a pharmacy with appropriate facilities
• occupational health and safety guidelines regarding the handling of cytotoxic drugs, including safe prescribing, preparation, dispensing, supplying, administering, storing, manufacturing, compounding and monitoring the effects of medicines (ACSQHC 2011)
• guidelines and protocols regarding delivery treatment safely (including dealing with extravasation of drugs)
• mechanisms for coordinating combined therapy (chemotherapy and radiation therapy), especially where facilities are not collocated.