Adult soft tissue sarcoma and time to treatment initiation: An analysis of the National Cancer Database

Curtis, Gannon L.; Lawrenz, Joshua M.; George, Jaiben; Styron, Joe F.; Scott, Jacob G.; Shah, Chirag; Shepard, Dale R.; Rubin, Brian P.; Nystrom, Lukas M.; Mesko, Nathan W.

doi:10.1002/jso.25095

Cited by 20 publications

(16 citation statements)

References 51 publications

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“…In the current study, Figure 3 delineates those factors that were attributed to increased or decreased TTI in PBS. As has been previously noted with soft tissue sarcoma, the single largest factor associated with increased TTI is a transition in care [ 12 ].…”

Section: Discussionmentioning

confidence: 90%

Adult Primary Bone Sarcoma and Time to Treatment Initiation: An Analysis of the National Cancer Database

Lawrenz

Curtis

Styron

et al. 2018

Sarcoma

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Objective The time to treatment interval (TTI), defined as the period from diagnosis to first definitive treatment, has very limited descriptions toward understanding delays in primary bone sarcoma (PBS) care. Our primary goal was to determine the national standard for time to treatment initiation (TTI) in PBS in adults and to identify characteristics associated with TTI variability. Methods An analysis of the National Cancer Database identified 15,083 adult patients with PBS diagnosed from 2004 to 2013. Kruskal–Wallis analysis identified differences between covariates regarding TTI and regression modeling identified covariates that independently influenced TTI. Results The median TTI was 22 days. Approximately 60% of patients were definitively treated in the same center where the index diagnosis was made. Increased TTI was correlated with a transition in care institution (incidence rate ratio (IRR) = 1.89; P < 0.001), being uninsured (IRR = 1.36; P < 0.001), primary tumor site in the pelvis (IRR = 1.26; P < 0.001), Medicaid insurance status (IRR = 1.22; P < 0.001), care at an academic center (IRR = 1.14; P < 0.001), non-white race (IRR = 1.12; P=0.002), and Medicare insurance status (IRR = 1.08; P=0.017). Decreased TTI was correlated with a diagnosis of chondrosarcoma (IRR = 0.85; P < 0.001), having surgery as the index treatment (IRR = 0.88; P < 0.001), a primary tumor site of the lower (IRR = 0.91; P=0.001) or upper extremity (IRR = 0.92; P=0.023), and stage II or stage III disease (IRR = 0.91; P=0.010). Conclusions TTI is associated with tumor, treatment, and socioeconomic and healthcare system characteristics. Transitions in care between institutions are responsible for the greatest increase in TTI. As TTI is more commonly used as a quality metric, physicians need to be aware of the causes for prolonged TTI, as we work to improve national delays in diagnosis and treatment initiation.

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Section: Discussionmentioning

confidence: 90%

Adult Primary Bone Sarcoma and Time to Treatment Initiation: An Analysis of the National Cancer Database

Lawrenz

Curtis

Styron

et al. 2018

Sarcoma

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“…Recent SEER-based studies have suggested that an association exists between insurance status and the presence of metastases at the diagnosis for certain soft tissue sarcoma subtypes [ 18 , 19 ]. Additionally, an NCDB study found that Medicare, Medicaid, or no insurance was correlated with increased time to treatment initiation, whereas median income > $63,000 was associated with shorter time to treatment initiation [ 20 ]. While the further analysis did not reveal these associations in our study cohort, there was an association between facility type and insurance status (P = 0.031).…”

Section: Discussionmentioning

confidence: 99%

Primary Site and Other Prognostic Factors for Fibrosarcoma: An Analysis of the National Cancer Database

Dahl¹,

Aurit²,

Silberstein³

et al. 2021

Cureus

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Purpose: Fibrosarcoma (FS) is a rare and malignant tumor that can occur in a variety of anatomic sites. The goal of this study is to use the National Cancer Database (NCDB) to analyze various factors affecting overall survival in FS and to be one of the rare studies to characterize the significance of the primary anatomic sites. Methods: The study cohort included 2,278 patients diagnosed with fibrosarcoma who received surgery from the NCDB. Kaplan-Meier curves, log-rank tests, and a multivariable Cox proportional hazard model were used to analyze the significance of factors affecting overall survival. Results: The head, face, and neck (HR = 1.44; 95% CI: 1.01-2.05; P = 0.046) and thorax anatomical sites (HR = 1.33; 95% CI: 1.02-1.73; P = 0.035) had a higher increased risk of death in comparison to the lower limb and hip. Compared to patients with private insurance, patients without insurance (HR = 1.99; 95% CI: 1.22 to 3.25; P = 0.006) and patients with Medicaid (HR = 1.99; 95% CI: 1.37 to 2.90; P < 0.001) had decreased overall survival. Patients associated with a zip code-level median household income ≥ $63,000 had a decreased risk of mortality when compared to lower income groups. Conclusion: In general, older patients with comorbidities, advanced-stage disease, and larger tumors who did not have private insurance and were from areas associated with lower income levels had poorer overall survival. No significant difference in overall survival was associated with receipt of neoadjuvant chemotherapy or neoadjuvant radiation.

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“…166 Conversely, a review of the NCDB identified 41,529 patients with STS and found that increased timing to treatment was associated with socioeconomic factors and issues within hospital systems. 167 Another factor seen in clinical treatment patterns includes variation in the management of extremity STS, where a study described age as being a factor of treatment, with young adults more likely to receive chemotherapy and less likely to receive RT when compared to older groups. 168 In a retrospective database review, the impact of age showed an overall lower local recurrence rate in primary amputations of elderly patients (over 90 years) when compared to limb salvage.…”

Section: Clinical Treatment Patterns and Outcomesmentioning

confidence: 99%

“…A retrospective cohort study described the interplay of social and tumor characteristics in determining diagnostic intervals, finding that tumor characteristics, rather than social factors, determined longer diagnostic intervals among patients 166 . Conversely, a review of the NCDB identified 41,529 patients with STS and found that increased timing to treatment was associated with socioeconomic factors and issues within hospital systems 167 . Another factor seen in clinical treatment patterns includes variation in the management of extremity STS, where a study described age as being a factor of treatment, with young adults more likely to receive chemotherapy and less likely to receive RT when compared to older groups 168 .…”

Section: Disparities Of Care In Stsmentioning

confidence: 99%

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas

Walker,

Simister,

Carr‐Ascher

et al. 2023

Journal of Surgical Oncology

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In this special edition update on soft tissue sarcomas (STS), we cover classifications, emerging technologies, prognostic tools, radiation schemas, and treatment disparities in extremity and truncal STS. We discuss the importance of enhancing local control and reducing complications, including the role of innovative imaging, surgical guidance, and hypofractionated radiation. We review advancements in systemic and immunotherapeutic treatments and introduce disparities seen in this vulnerable population that must be considered to improve overall patient care.

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Adult soft tissue sarcoma and time to treatment initiation: An analysis of the National Cancer Database

Abstract: The median TTI in the United States for STS is 22 days. Increased TTI in STS are associated with tumor and treatment characteristics, socio-economic factors and hospital systems issues. Transitions in care between institutions are responsible for the greatest increases.

Cited by 20 publications

References 51 publications

Adult Primary Bone Sarcoma and Time to Treatment Initiation: An Analysis of the National Cancer Database

Adult Primary Bone Sarcoma and Time to Treatment Initiation: An Analysis of the National Cancer Database

Primary Site and Other Prognostic Factors for Fibrosarcoma: An Analysis of the National Cancer Database

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas

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