Socio-economic factors do not affect overall survival in soft tissue sarcoma when patients treated at a single high-volume center

Abstract

Background Treatments for soft tissue sarcoma (STS) include extensive surgical resection, radiation and chemotherapy, and can necessitate specialized care and excellent social support. Studies have demonstrated that socioeconomic factors, such as income, marital status, urban/rural residence, and educational attainment as well as treatment at high-volume institution may be associated with overall survival (OS) in STS. Methods In order to explore the effect of socio-economic factors on OS in patients treated at a high-volume center, we performed a retrospective analysis of STS patients treated at a single institution. Results Overall, 435 patients were included. Thirty-seven percent had grade 3 tumors and 44% had disease larger than 5 cm. Patients were most commonly privately insured (38%), married (67%) and retired or unemployed (43%). Median distance from the treatment center was 42 miles and median area deprivation index (ADI) was 5 (10 representing most deprived communities). The majority of patients (52%) were treated with neoadjuvant therapy followed by resection. As expected, higher tumor grade (HR 3.1), tumor size > 5 cm (HR 1.3), and involved lymph nodes (HR 3.2) were significantly associated with OS on multivariate analysis. Demographic and socioeconomic factors, including sex, age at diagnosis, marital status, employment status, urban vs. rural location, income, education, distance to the treatment center, and ADI were not associated with OS. Conclusions In contrast to prior studies, we did not identify a significant association between socioeconomic factors and OS of patients with STS when patients were treated at a single high-volume center. Treatment at a high volume institution may mitigate the importance of socio-economic factors in the OS of STS.

No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks’ Outcome?

“…Our results complete and shed new light on another study observing no association between social deprivation and the survival of soft-tissue sarcoma patients conducted in the specific setting of a retrospective analysis in the single high-volume University of Washington Medical Center. According to this results, Eastman et al suggest that “treatment at a high volume institution may mitigate the importance of socio-economic factors in the overall survival of soft-tissue sarcomas” [ 44 ]. Mandatory referral of all patients to reference centers is interesting to reduce inequalities in cancer management and survival, but here we found that such results can also be achieved through a more flexible organization driven by a reference network, following the model of hub and spoke, and which can help to avoid some potential adverse effects for patients related to the variable spatial accessibility of these reference centers [ 22 ] and the cumulative impact of long journeys on quality of life [ 45 ].…”

Sarcoma Care Collaborations: Models for patient centered sub-specialty oncology care in the COVID-19 era and beyond

“…The portability of pathology and imaging results without a requirement for patient travel has the promise of revolutionizing care structures for rare cancers. Treatment at a referral center has been shown to normalize oncologic outcomes regardless of socioeconomic status, 24 and the goal would be that by maintaining the flow of communication and taking advantage of emerging technologies, all sarcoma patients regardless of location will have access to multidisciplinary sarcoma care.…”

Is rare cancer care organized at national health system level? Multiple case study in six EU countries

“…17 In fact, different studies have shown better survival in sarcoma patients managed by expert centres. [18][19][20][21] Thus, it is imperative that the countries following the centre-based model, where there are no collaboration mechanisms between expert and non-expert centres, facilitate patients' access to RCs. Lithuania, with 3 million inhabitants and two RCs, implemented a system to capture the patients who need their services.…”