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

Income and Insurance-Based Disparities in Primary Soft Tissue Sarcoma of the Extremities

BACKGROUND AND OBJECTIVES

Soft tissue sarcomas (STSs) are rare but can be devastating. Paradigm shifts in adjuvant treatment have expanded the availability of limb salvage; however, a subset of patients still require amputation. The aim of this study was to examine the impact of patient, disease, and practice-related factors on rates of amputation in STS.

METHODS

All adults undergoing resection for STS of the extremities were tabulated from the 2004-2021 National Cancer Database (NCDB). Multivariable models were utilized to evaluate risk factors for undergoing amputation.

RESULTS

Of 31 805 patients, 1880 (6%) underwent amputation. Those who underwent amputation were younger (57 vs. 60, p < 0.001), more commonly Black (12% vs. 9%, p < 0.00), and more frequently Medicaid insured (11% vs. 6%, p < 0.001). Amputation patients experienced a longer time from diagnosis to surgery, compared to limb salvage patients (46 [23-91] vs. 37 days [9-93], p < 0.001). Amputation was associated with a significantly greater hazard of overall mortality over 10 years following resection (HR 1.66, p < 0.001).

CONCLUSION

We report significant race-, income-, and insurance-based disparities in amputation risk and overall survival for patients with STS of the extremities. We also report a significantly increased risk of amputation for patients with delayed clinical presentation. Multidisciplinary sarcoma care teams should be aware of these disparities.

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

BACKGROUND

As a system of European Reference Networks (ERNs) emerges, the differences in quality of care for patients with rare cancers may increase at national level. We aimed to elucidate the processes and healthcare planning principles through which the reference centres (RCs) for rare cancers are embedded in national health systems.

METHODS

We used a multiple case-study design based on the experiences of Czechia, Finland, France, Italy, Lithuania and Spain. Using sarcoma as an example of rare cancer, 52 semi-structured interviews were conducted during on-site visits, including a multidisciplinary group of professionals, Ministry of Health professionals, patient representatives and European policymakers.

RESULTS

The comparative analysis showed substantial heterogeneity in the processes for formalizing RCs' status and in their levels of integration in the different health systems, but two models (centre-based and the network-based) can be envisaged at national level. RCs for rare cancers were legally established only in France and Spain. Expert clinicians cooperate in a structured way, using network mechanisms, in France and Italy, and these countries, plus Finland and Lithuania, had a referral system to facilitate patients' access from non-expert centres to RCs. Seven key healthcare planning principles in instituting RCs at the national level were identified.

CONCLUSIONS

The conditions governing patient access to treatment centres-whether RCs or not-are decided at the national level. It is advisable to progressively align the European and national levels so that the RCs that participate in the ERNs also play a significant role at the national level.

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

The national reference network NETSARC+ provides remote access to specialized diagnosis and the Multidisciplinary Tumour Board (MTB) to improve the management and survival of sarcoma patients in France. The IGéAS research program aims to assess the potential of this innovative organization to address geographical inequalities in cancer management. Using the IGéAS cohort built from the nationwide NETSARC+ database, the individual, clinical, and geographical determinants of the 3-year overall survival of sarcoma patients in France were analyzed. The survival analysis was focused on patients diagnosed in 2013 (n = 2281) to ensure sufficient hindsight to collect patient follow-up. Our study included patients with bone (16.8%), soft-tissue (69%), and visceral (14.2%) sarcomas, with a median age of 61.8 years. The overall survival was not associated with geographical variables after adjustment for individual and clinical factors. The lower survival in precarious population districts [HR 1.23, 95% CI 1.02 to 1.48] in comparison to wealthy metropolitan areas (HR = 1) found in univariable analysis was due to the worst clinical presentation at diagnosis of patients. The place of residence had no impact on sarcoma patients' survival, in the context of the national organization driven by the reference network. Following previous findings, this suggests the ability of this organization to go through geographical barriers usually impeding the optimal management of cancer patients.