Purpose: To evaluate the educational content, quality, and reliability of YouTube videos regarding the Achilles tendon and Achilles tendon injuries.Methods: The first 50 videos found on YouTube after searching "Achilles tendon" were evaluated and classified by content type and uploader source. Reliability and accuracy were assessed using the Journal of the American Medical Association (JAMA) benchmark criteria, nonspecific educational content was assessed via the Global Quality Score (GQS), and specific educational content was assessed using the Achilles Tendon Specific Score (ATSS). ANOVA was performed to determine differences in video reliability and educational content quality by video content type and source. Multivariate stepwise regressions were used to evaluate the effects of specific video characteristics on JAMA benchmark criteria, GQS, and ATSS.Results: The 50 videos evaluated had a cumulative view total of 53,323,307, a mean of 1,066,466, and a range of 1,009 to 42,663,665 views per video. Most videos focused on disease-specific information (38%) and exercise training (22%). Most videos were uploaded by non-physicians (34%) or medical sources (health websites) (32%). A higher view ratio was an independent predictor of lower JAMA scores (lower reliability and accuracy) (standardized beta = −0.281, P = 0.048) and increased video duration was an independent predictor of greater GQS (standardized beta = 0.380, P = 0.007) and ATSS scores (standardized beta = 0.364, P = 0.009) (increased quality of nonspecific and specific educational content).Conclusion: Videos on YouTube regarding the Achilles tendon were viewed numerous times, but their educational content and reliability were poor. Providers treating patients for Achilles tendon-related pathologies should initiate a dialogue with patients about their use of internet sources and should educate them on their optimal usage. They should warn them of the low quality of YouTube-derived information and provide them with reliable sources that may better give them control over their own care.

Purpose: Ewing sarcoma is a primary malignant bone tumor that manifests predominantly in the proximal long bones and pelvis and traditionally presents with nonspecific symptoms. This tumor preferentially affects children and young adults, occurring most often in patients of European descent. The most important established prognostic factor is the presence of metastasis at the time of diagnosis followed by primary site, size of the primary neoplasm, patient age, and lactate dehydrogenase (LDH) levels. To the authors’ knowledge, this is the first study focused on the effects of socioeconomic and geographic factors on overall survival in Ewings sarcoma. Methods: A total of 3,920 patients diagnosed with Ewing sarcoma were identified in the National Cancer Database (NCDB) using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) code 9260. Of these, 3,238 met the inclusion criteria and were analyzed. Descriptive statistics, Kaplan-Meier survival curves, and Cox regression tables were all performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States). Results: Univariate analysis showed greater mortality for patients of increasing age at the time of diagnosis, at two, five, and 10 years of follow-up, Black race patients at two years, Medicare insurance status at two years, urban or rural residence at two and 10 years, more advanced tumor stage at two and five years, and patients with a comorbidity score of ≥2 at two years. Multivariate analysis showed greater mortality at two years with increasing age, Black race, uninsured status, urban or rural residence, and increasing tumor stage. Mortality also increased for patients at five years of follow-up in patients with increasing age or more advanced tumor stage. Conclusion: Patient mortality in the first two years after diagnosis is increased for patients of the Black race, those living in urban or rural areas, and for patients that are uninsured or using Medicare as their primary payor at the time of diagnosis. To improve patient outcomes, clinicians should recognize and address not only the unique biology of patients but also their unique challenges in access to healthcare. Patients and providers should work to elicit changes on an individual and community level to improve their personal health and the health of those around them.

e23506 Background: There are significant differences in prognosis for osteosarcoma, Ewing Sarcoma, chondrosarcoma, & chordomas based on stage at diagnosis. 5-year survival at early stage vs late stage is as follows; osteosarcoma 75% vs 27%, Ewing sarcoma 82% vs 39%, chondrosarcoma 78% vs 22%, and chordomas 87% vs 55%. This study seeks to evaluate the socioeconomic and geographical factors that affect the odds of late-stage bone cancer diagnosis. Methods: This study retrospectively evaluated the risk of stage I vs stage IV cancer at diagnosis in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma & chordoma) diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2018. Patients were identified by ICD-O-3 codes and patients with other malignancies were excluded. Cross Tabulations with Chi-square analysis was performed to evaluate frequencies of different socioeconomic and geographical characteristics between groups. Multivariable binary logistic regression was performed to evaluate relationships between socioeconomic and geographical factors and the odds of stage IV cancer. Statistical significance was set at α = 0.05. Results: 11,945 patients with stage I or stage IV primary malignant bone tumors were identified. Odds of stage IV bone cancer at diagnosis increased in patients of greater age (odds ratio [OR] = 1.011, 95% confidence interval [CI]: 1.003-1.018). Odds of stage IV bone cancer at diagnosis were decreased with female sex (OR = 0.747, 95% CI: 0.647-0.862), private insurance (OR = 0.519, 95% CI: 0.367-0.732), Medicare insurance (OR = 0.664, 95% CI: 0.456-0.965), or with diagnosis at comprehensive cancer center programs (OR = 0.549, 95% CI: 0.371-0.814), academic/research programs (OR = 0.339, 95% CI: 0.232-0.495), or integrated cancer network programs (OR = 0.392, 95% CI: 0.261-0.587). No significant relationship was identified between stage at diagnosis and race, ethnicity, Charlson-Deyo score, income, education, region, travel distance, or urban/rural status. Conclusions: Odds of stage IV bone cancer at diagnosis are greater with increasing age, male sex, non-private or non-Medicare insurance status, or treatment at community cancer programs.

Background: There are significant differences in prognosis for osteosarcoma, Ewing sarcoma, chondrosarcoma, and chordomas based on the stage at diagnosis. The five-year survival of these bone cancers varies from 75-87% at an early stage of diagnosis and falls to 27-55% at a late stage of diagnosis.Patients and methods: This study retrospectively evaluated the odds of stage I vs stage IV cancer at the time of diagnosis in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma and chordoma) diagnosed in the National Cancer Database (NCDB) between 2004 and 2018. Cross tabulations with Chi-square analysis were performed to evaluate frequencies of different socioeconomic and geographical characteristics between patients with stage I vs stage IV cancer. Multivariable binary logistic regression was performed to evaluate relationships between socioeconomic and geographical factors and the odds of stage IV cancer at the time of diagnosis. Statistical significance was set at α = 0.05.Results: 8882 patients with stage I and 3063 with stage IV primary malignant bone tumors were identified. The odds of stage IV bone cancer at diagnosis are increased for patients on Medicaid (odds ratio [OR] = 1.298, 95% confidence interval [CI]: 1.043-1.616) or Medicare (OR = 1.795, 1.411-2.284). Odds of stage IV bone cancer at diagnosis were decreased with female sex (OR = 0.733, 0.671-0.800), private insurance (OR = 0.738, 0.601-0.905), and those treated at community cancer programs (OR = 0.542, 0.369-0.797), comprehensive cancer program (OR = 0.312, 0.215-0.452), or academic/research facilities (OR = 0.370, 0.249-0.550). No significant relationship was identified between the stage at diagnosis and race, ethnicity, Charlson-Deyo score, or education level. Stage IV cancer at diagnosis showed was proportionally lower in chondrosarcomas (17.1%) and chordomas (2.1%) than osteosarcomas (45.0%) and Ewing sarcomas (35.8%).Conclusion: Odds of stage IV bone cancer at diagnosis are greater with male sex, Medicaid or Medicare insurance status, or treatment at community cancer programs. Providers should have a low suspicion for additional evaluation when treating patients with symptoms of bone cancer and should be aware of these disparities when treating people in these groups. This is to the authors' knowledge the first such study conducted through the NCDB.

Background: Osteosarcoma is the most common form of bone cancer, but the utilization of palliative care (PC) in patients with this cancer has not previously been investigated in the National Cancer Database (NCDB). Methods: Patients diagnosed with osteosarcoma (2004-2017) were identified within the NCDB. Cross tabulations with Chi-square analysis were performed to evaluate frequencies of palliative care use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of palliative care. Results: A total of 7498 patients were analyzed with 2.8% of patients diagnosed having any form of palliative care utilization. Of this group, 53.37% received PC within the first 12 months after diagnosis. Of the 2.8% of patients receiving PC the most common forms of PC utilized were non-curative symptom-directed surgery, radiation, or chemotherapy, or a combination of these modalities (56.7%). Palliative care usage was increased in patients with greater tumor diameter, tumors in the bones of the midline, or stage IV tumors. Palliative care usage was decreased in patients living within 25-49 miles of their treatment facility, those living in pacific states, those with chondroblastic osteosarcoma, or those with private insurance. Conclusion: Palliative care use in patients with osteosarcoma increases with tumor stage, tumor size, or more proximal tumors, but overall utilization remains markedly low. Future studies should further define these patterns of care and help expand the utilization of PC.