Oncology is the ultimate team sport. Diagnosis requires the collaboration of clinicians, pathologists, and radiologists. Treatment is multimodal, often requiring input from medical, surgical, and radiation experts. Improved patient outcomes are seen when multidisciplinary teams coordinate care and individual providers do not work in isolation [1, 2]. Misaligned priorities among specialists and between providers and patient are the most common source of suboptimal care. The solution to this problem is often simple: better communication.

Tumor boards are often used to facilitate this communication. Providers from different sub-specialties are brought together to coordinate a consensus treatment plan, and optimally, to continue to refine this treatment plan throughout the patient’s clinical course [3]. However, as tumor boards are often disease-specific, orthopedic surgeons often are far better at communicating with sarcoma medical oncologists with whom they regularly meet than medical oncologists from other fields. While the orthopedic oncologist would ideally attend breast, lung, thyroid, renal, and prostate tumor boards (among others) to ensure communication with these respective medical oncologists, this is often not practical and therefore alternative methods of communication must be employed when treating metastatic disease. Additionally, while the bulk of sarcoma care is provided by orthopedic oncologists, much of the surgical treatment for metastatic disease is performed by general orthopedic providers. These providers often do not have the same access to medical oncologists that orthopedic oncologists enjoy, leading to additional challenges to interdisciplinary care and good communication.

This chapter will address one aspect of this essential communication between providers: questions the orthopedic surgeon may want to ask his or her medical oncology colleagues. The chapter focuses on questions surrounding the treatment of metastatic lesions, and not questions relating to making the diagnosis, as this is covered in other chapters. Nonetheless, one cannot overstate the importance of good communication in formulating a diagnosis, as proper care is predicated on appropriate tissue diagnosis. No surgical plan should be made without a confirmation of tissue diagnosis with the medical oncology team, and if the diagnosis is in question, a discussion of biopsy prior to surgery should be thoroughly vetted.

This chapter lists a set of questions and topics that the orthopedic surgeon may want to raise with the medical oncologist prior to surgery. This chapter is not intended to be comprehensive, but hopefully will provide a framework from which the orthopedic surgeon can approach the medical oncologist. Most importantly, an open chain of communication, with regular updates and real-time flow of information is essential as patient health, expectations, and treatment priorities are often fluid.