Disparities in Cancer Care: The Example of Sarcoma—In Search of Solutions for a Global Issue

Abstract

Disparities in health care have an adverse effect on the outcome of disadvantaged patients with cancer. Patients may be at a disadvantage because of geographic isolation; insurance status; or racial, ethnic, or other factors. In this article, we examine how disparities affect the care of patients with sarcoma in the United States, Canada, and the Asia-Pacific region. Because of the rarity of sarcomas and their challenging diagnosis and complex treatment patterns, some professional or national guidelines stipulate that patients with sarcoma should be treated at centers of expertise by multidisciplinary teams. This recommendation, based on published evidence, is not always applicable because of various sociopolitical or patient-related factors. We are proposing solutions to overcome these obstacles in a practical and patient-centered way while acknowledging that disparities exist among countries as well as within any country.

Effects of time to treatment initiation on outcomes for soft tissue sarcomas

“…A hybrid approach to follow-up appointments between the sarcoma specialists and patient's local orthopedic/oncological specialists are also an effective method. 26 These strategies have been utilized in New Zealand more frequently over the recent years, in efforts to reduce barriers and inequities of healthcare.…”

“…Future studies will have to focus on the long‐term ramifications of the excessive delays from COVID‐19. Consequent from the pandemic, however, Telehealth/Virtual clinics have become more widely used as more efficient methods for follow‐up consultations 26,27 . They can reduce delay of follow‐up appointments and mitigate the distance and resources required for patients in rural areas as well as those of low socioeconomic backgrounds.…”

“…New Zealand has three hospitals with the centralized, multidisciplinary expertise and resources required for optimal treatment 25 . For some patients living in regional and rural areas, the distance and costs of travel to these tertiary referral centers can be debilitating 26 . Hence, this raises the potential issue of disparities in terms of provision of timely care for patients who reside in regional/rural areas, compared to those who live in major cities.…”

An international working group consensus report for the prioritization of molecular biomarkers for Ewing sarcoma

“…If not recognized and mitigated, these disparities can be especially profound for patients who suffer from rare diseases. Given their relative rarity, sarcomas, including EwS, present diagnostic challenges and centralized pathology review has been shown to greatly increase diagnostic accuracy in several cooperative sarcoma studies 116 – 118 . In the US, the NCCN guidelines now recommend diagnosis at an institute with access to NGS testing.…”

“…In the US, the NCCN guidelines now recommend diagnosis at an institute with access to NGS testing. In addition, patients with EwS receive complex multi-disciplinary care that most often requires travel to an urban center, a factor that amplifies inequities 116 . Moreover, given the unique challenges faced by AYA patients, the increased prevalence of EwS in this under-represented patient population compounds the potential for disparities in both access and outcomes 119 .…”