Abstract
Recent studies in cancer treatment have identified higher perioperative mortality and lower long-term survival among blacks relative to whites. The largest disparities in survival occur among patients with solid tumors for which appropriate and high quality treatment is an important prognostic factor. Soft tissue sarcomas (STS) require specialized multidisciplinary care. However, the influence of race/ethnicity has not been examined.
A single institution retrospective study was performed on all high grade STS of the extremities treated from 1991 thru 2007. Multivariate analyses including gender, age, race, disease stage, tumor size, presentation at multidisciplinary conference, prior surgery, comorbidities, definitive surgery, margin, chemotherapy, radiation, distance to hospital, income and payor method were conducted to assess association with overall survival (OS) and event-free survival (EFS). Distributions of patient characteristics were assessed, unadjusted OS and EFS distributions were estimated and compared between subgroups, and effects of covariates on OS and EFS were assessed using standard statistical techniques.
The study included 697 patients (311 females and 386 males) with high grade STS. 9.6% were African American (AA), 73.9% were White and 16.5% were Hispanic. 7.0 yrs (95%CI: 6.6–7.4 yrs). Age, male, AA, large tumor size, chemotherapy and no insurance were significantly associated with shorter OS and EFS. Stage 3/4 disease and radiation were significantly associated with OS and EFS, respectively. African Americans presented with larger tumor size (p<0.0001), a higher rate of metastatic disease (p=.001), and in univariate analyses, had worse OS (p<0.001) and EFS (p=.0022). Patients with low/middle income or without medical insurance had worse OS. African Americans and Hispanics had significantly lower income compared to Whites (p<0.0001), and were less likely to have medical insurance (p<0.0001). Among the uninsured, African Americans had worse OS (p<0.0001).
Despite treatment at a comprehensive cancer center, African Americans with STS universally had poorer outcomes. The cause for these racial disparities is multifactorial and encompasses both patient factors and health care system effects. The higher mortality of African Americans seen here may be due to underuse of primary medical care, resulting in later disease stage at diagnosis.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A63.
