Impact of racial disparities and insurance status in patients with bone sarcomas in the USA

Abstract

Aims Socioeconomic and racial disparities have been recognized as impacting the care of patients with cancer, however there are a lack of data examining the impact of these disparities on patients with bone sarcoma. The purpose of this study was to examine socioeconomic and racial disparities that impact the oncological outcomes of patients with bone sarcoma. Methods We reviewed 4,739 patients diagnosed with primary bone sarcomas from the Surveillance, Epidemiology and End Results (SEER) registry between 2007 and 2015. We examined the impact of race and insurance status associated with the presence of metastatic disease at diagnosis, treatment outcome, and overall survival (OS). Results Patients with Medicaid (odds ratio (OR) 1.41; 95% confidence interval (CI) 1.15 to 1.72) and uninsured patients (OR 1.90; 95% CI 1.26 to 2.86) had higher risks of metastatic disease at diagnosis compared to patients with health insurance. Compared to White patients, Black (OR 0.63, 95% CI 0.47 to 0.85) and Asian/Pacific Islander (OR 0.65, 95% CI 0.46 to 0.91) were less likely to undergo surgery. In addition, Black patients were less likely to receive chemotherapy (OR 0.67, 95% CI 0.49 to 0.91) compared to White patients. In patients with chondrosarcoma, those with Medicaid had worse OS compared to patients with insurance (hazard ratio (HR) 1.65, 95% CI 1.06 to 2.56). Conclusion In patients with a bone sarcoma, the cancer stage at diagnosis varied based on insurance status, and racial disparities were identified in treatment. Further studies are needed to identify modifiable factors which can mitigate socioeconomic and racial disparities found in patients with bone sarcomas. Cite this article: Bone Joint Res 2022;11(5):278–291.

Disparities in incidence and survival for patients with Ewing sarcoma in Florida

“…Reduced access to care and lower SES typically can lead to delayed presentation of disease, delayed treatment of disease, overall decreased participation in clinical trials and therefore worse outcomes in ES. A study utilizing the SEER database to evaluate all bone sarcomas noted higher risk of metastatic disease at presentation for those Medicaid or no insurance when compared with those with private health insurance 4 . Insurance status and SES were not found to be statistically significant in our study.…”

“…The impact of racial and ethnic disparities on ES outcomes has been investigated on a national scale using the Surveillance, Epidemiology, and End Results (SEER) cancer surveillance data 2,4,5 . These studies have highlighted increased mortality among Hispanic patients, non‐Hispanic Black (NHB) patients, and those residing in economically disadvantaged areas 2,5,6 .…”

Socioeconomic disparities in musculoskeletal oncology

“…Due to its relatively rare incidence, disease specific research into the impact of SDOH and outcomes in patients with chondrosarcoma is even more limited than the previously reviewed disease entities. There is some literature, however, which does report that insurance related disparities exist in patients diagnosed with chondrosarcoma 40 …”

“…There is some literature, however, which does report that insurance related disparities exist in patients diagnosed with chondrosarcoma. 40…”

Association of Socioeconomic Status With Worse Overall Survival in Patients With Bone and Joint Cancer

“…Black patients are less likely to undergo surgery as compared with White patients. 19 In 2011, the US Department of Health and Human Services initiated an action plan to reduce disparities in surgical utilization procedures, 20 yet recent literature suggests that these disparities persist and have worsened in some cases. 21 Studies looking at surgery refusal rates among patients with cancer have highlighted several factors that lead to higher odds of refusal.…”