Socioeconomic and insurance‐related disparities in disease‐specific survival among patients with metastatic bone disease

Abstract

Background: Approximately 5% of cancer patients in the United States presented with metastatic bone disease (MBD) at diagnosis. Current study explores the disparities in survival for patients with MBD. Methods: Patients with the diagnosis of MBD at presentation for the five most common primary anatomical sites were extracted from Surveillance, Epidemiology, and End Results Census tract-level dataset (2010-2016). Kaplan-Meier and Cox Proportional Hazard models were used to evaluate survival, and prognostic factors for each cohort. Prognostic significance of socioeconomic status (SES) and insurance status were ascertained.Results: The five most common anatomical-sites with MBD at presentation included "lung" (n = 59 739), "prostate" (n = 19 732), "breast" (n = 16 244), "renal and urothelium" (n = 7718) and "colon" (n= 3068). Lower SES was an independent risk factor for worse disease-specific survival (DSS) for patients with MBD originating from lung, prostate, breast and colon. Lack of insurance was an independent risk factor for worse DSS for MBD patients with primary tumors in lung and breast.Conclusions: MBD patients from the five most common primary sites demonstrated SES and insurance-related disparities in disease-specific survival. This is the first and largest study to explore SES and insurance-related disparities among patients specifically afflicted with MBD. Our findings highlight vulnerability of patients with MBD across multiple primary sites to financial toxicity.

Socioeconomic disparities in musculoskeletal oncology

“…Similarly, non‐Hispanic American Indian/Alaskan Native had higher incidence of MBD for cancers originating from renal and colon 1 . SES (lung, prostate, breast, and colon) and insurance‐related (lung and breast) disparities in survival were also seen among patients with MBD 2 …”

“…1 SES (lung, prostate, breast, and colon) and insurance-related (lung and breast) disparities in survival were also seen among patients with MBD. 2 The impact of SDOH on MBD is especially impactful on the general population health given the relative prevalence of MBD. More than 250 000 people in the United States are living with MBD, 48,49 and this number continues to increase as advances in oncologic care lead to increased survival time from time of diagnosis.…”

“…In contrast, evidence regarding health care disparities surrounding MBD has been rather limited in comparison. Our group recently highlighted the widespread disparities in incidence 1 and survival 2 among patients with MBD from five most common primary sites utilizing the SEER database. A plethora of evidence in the current literature has highlighted disparities in incidence, stage at presentation and survival with respect to various primary sites 18–26 .…”

“…Oncologic processes impacting the musculoskeletal (MSK) systems can be widely divided into metastatic cancers, hematologic malignancies with musculoskeletal manifestations, and primary bone cancers. Metastatic bone disease (MBD) is by far the most common oncologic process affecting skeletal system, 1,2 followed by multiple myeloma (MM) 3,4 . The most common primary bone malignancies include osteosarcoma, 5 followed by Ewing sarcoma (ES) 6 and chondrosarcoma 7 .…”

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

“…Orthopaedic oncologists play a critical role in the management of these patients living with metastatic bone disease, including planning prophylactic stabilization or reconstruction for patients with high risk of impending pathologic fracture. 16 Recently, in the field of musculoskeletal oncology, several prognostic machine learning algorithms have been developed to predict survivorship in patients who undergo surgery for metastatic bone disease. 10 However, the utility of social determinants of health as prognostic factors for survivorship has not been adequately studied.…”