Racial and ethnic disparities in treatment and survival of pediatric sarcoma

Jacobs, A. J.; Lindholm, Erika; Levy, Carolyn Fein; Fish, Jonathan D.; Glick, Richard D.

doi:10.1016/j.jss.2017.05.031

Cited by 32 publications

(42 citation statements)

References 18 publications

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“…Independently, those patients in areas of highest poverty had decreased overall survival when compared with areas of lower poverty. Our findings in pediatric brain tumors are consistent with previous studies showing disparities in outcomes for racial and ethnic minorities in other adult and pediatric cancers 3,6,7 . These prior studies have shown Black race and Hispanic ethnicity to be associated with poorer survival and/or later stage disease at presentation, although one study showed some mitigation by accounting for socioeconomic measures 7 .…”

Section: Discussionsupporting

confidence: 92%

“…For instance, it has been shown that access to private insurance compared to Medicaid or no insurance positively affects the prognosis of adult glioblastoma patients leading to better overall survival 4 . While less studied in the pediatric population, data exist demonstrating disparities of care and survival in pediatric oncology patients based on socioeconomic and racial/ethnic factors [5][6][7] . In the U.S., malignant neoplasms are the leading cause of death by disease in children past infancy.…”

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confidence: 99%

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Population-Based Analysis of Demographic and Socioeconomic Disparities in Pediatric CNS Cancer Survival in the United States

Fineberg

Zahedi

Eguchi

et al. 2020

Sci Rep

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Previous studies have demonstrated effects of racial and socioeconomic factors on survival of adults with cancer. While less studied in the pediatric population, data exist demonstrating disparities of care and survival in pediatric oncology patients based on socioeconomic and racial/ethnic factors. Brain cancers recently overtook leukemia as the number one cause of childhood cancer fatalities, but demographic and socioeconomic disparities in these tumors have not been adequately studied. We obtained data from the SeeR program of the national cancer institute (nci). We selected patients under 19 years of age with central nervous system (CNS) cancers diagnosed between 2000 and 2015. We included patient demographics, tumor characteristics, treatment, and socioeconomic characteristics as covariates in the analysis. We measured overall survival and extent of disease at diagnosis. We saw that Black and Hispanic patients overall had a higher risk of death than non-Hispanic White patients on multivariable analysis. On stratified analysis, Black and Hispanic patients with both metastatic and localized disease at diagnosis had a higher risk of death compared to White, non-Hispanic patients, although the difference in Black patients was not significant after adjusting for mediating factors. However, our findings on extent of disease at diagnosis demonstrated that neither Black race nor Hispanic ethnicity increased the chance of metastatic disease at presentation when controlling for mediating variables. In summary, racial and ethnic disparities in childhood CNS tumor survival appear to have their roots at least partially in post-diagnosis factors, potentially due to the lack of access to high quality care, leading to poorer overall outcomes.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Population-Based Analysis of Demographic and Socioeconomic Disparities in Pediatric CNS Cancer Survival in the United States

Fineberg

Zahedi

Eguchi

et al. 2020

Sci Rep

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“…Results from analyses of race/ethnicity are limited by the extreme rarity of the disease, often constraining investigators to analyze histologically distinct sarcoma subtypes as a single group (eg, sarcoma) and few adjusted for likely confounding by SES. 17,18 Of note, a genome-wide association study 19 of osteosarcoma identified 2 germline genetic variants that were associated with an increased risk of metastases. This indicates that the metastatic potential for at least 1 sarcoma subtype is present at the start of tumorigenesis and not solely through sequential accumulation of mutations during disease progression.…”

Section: Introductionmentioning

confidence: 99%

Associations of Socioeconomic Status, Public vs Private Insurance, and Race/Ethnicity With Metastatic Sarcoma at Diagnosis

et al. 2020

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IMPORTANCE Approximately 10% to 30% of patients with sarcoma present with detectable metastases at diagnosis. However, the extent to which presentation with metastases is due to delayed diagnosis vs other factors remains unclear. OBJECTIVE To evaluate whether socioeconomic status, insurance status, or race/ethnicity were associated with the presence of metastases at diagnosis of sarcoma. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the populationbased Surveillance, Epidemiology, and End Results program. Adult and pediatric patients with an initial diagnosis of soft-tissue and bone sarcoma between 2001 and 2015 were stratified by age group (pediatric, <20 years; adult, 20-65 years; older adult, >65 years) and sarcoma subtype. Statistical analyses were performed between August 2019 and January 2020. EXPOSURES Surveillance, Epidemiology, and End Results Census tract-level socioeconomic status index, insurance status, and race/ethnicity. MAIN OUTCOMES AND MEASURES The odds of presenting with metastases at diagnosis were calculated. RESULTS A total of 47 337 patients with first primary malignant sarcoma were included (24 343 male patients [51.4%]), with 29 975 non-Hispanic White patients (63.3%), 5673 non-Hispanic Black patients (12.0%), 7504 Hispanic patients (15.8%), and 4185 American Indian-Alaskan Native and Asian Pacific Islander patients (8.8%). Liposarcoma in adults was the only subtype and age group combination that demonstrated a significant trend in incidence across socioeconomic status levels (odds ratio, 0.85; 99% CI, 0.76-0.96; P = .001). However, compared with having non-Medicaid insurance, having Medicaid or no insurance in adults was associated with an increased odds of metastases at diagnosis for 6 of the 8 sarcoma subtypes evaluated; osteosarcoma and Ewing sarcoma were the only 2 subtypes in adults for which metastases were not associated with insurance status. In addition, there was an increased risk of presenting with metastases among non-Hispanic Black adults diagnosed with leiomyosarcoma (odds ratio, 1.87; 99% CI, 1.41-2.48) and unclassified sarcomas (odds ratio, 1.65; 99% CI, 1.01-2.67) compared with non-Hispanic White adults that was independent of socioeconomic and insurance status. CONCLUSIONS AND RELEVANCE These findings suggest that delayed access to care is associated with advanced stage at diagnosis for several soft-tissue sarcoma subtypes in adults, whereas other factors may be associated with the metastatic progression of osteosarcoma and Ewing sarcoma, as well as the racial disparities observed with metastatic leiomyosarcoma and unclassified sarcomas.

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“…[8][9][10][11][12] Previous research suggests that racial and ethnic differences exist regarding delays in presentation and outcomes for sarcomas in the pediatric population. [13][14][15] Differences in age at diagnosis and frequencies of certain cancer subtypes have been also found to exist among certain racial and ethnic groups, suggesting potential biologic differences.…”

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confidence: 99%

Socioeconomic and health care coverage disparities in children, adolescents, and young adults with sarcoma

Westermann

Weller

Pedroso

et al. 2020

Pediatric Blood & Cancer

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Background: Socioeconomic and health care coverage disparities are established as poor prognostic markers in adults with sarcoma, but few studies examine these differences among pediatric, adolescents and young adults (AYA). This study examines the association between socioeconomic status (SES), insurance status, and disease presentation among children and AYA patients with sarcoma. Methods: This is a retrospective cohort study of patients aged 0-25 years with bone or soft tissue sarcoma from the National Cancer Database. SES assignments were based on estimated median income and education level. Patient demographics and clinical factors were compared by SES and insurance status. Multivariate logistic regression models were fitted to determine adjusted odds ratios of SES and insurance status on metastatic disease or tumor size ≥5 cm at time of presentation. Results: In a cohort of 9112 patients, 2932 (32.1%) had low, 2084 (22.8%) middle, and 4096 (44.9%) high SES. For insurance status, 5864 (64.3%) had private, 2737 (30.0%) public, and 511 (5.6%) were uninsured. Compared to high SES, patients with low SES were more likely to have metastatic disease (OR = 1.16, P = .03) and tumors ≥5 cm (OR = 1.29, P < .01). Compared to private insurance, public and no insurance were associated with metastatic disease (

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Racial and ethnic disparities in treatment and survival of pediatric sarcoma

Cited by 32 publications

References 18 publications

Population-Based Analysis of Demographic and Socioeconomic Disparities in Pediatric CNS Cancer Survival in the United States

Population-Based Analysis of Demographic and Socioeconomic Disparities in Pediatric CNS Cancer Survival in the United States

Associations of Socioeconomic Status, Public vs Private Insurance, and Race/Ethnicity With Metastatic Sarcoma at Diagnosis

Socioeconomic and health care coverage disparities in children, adolescents, and young adults with sarcoma

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