Pediatric patients with soft tissue sarcoma, public insurance may have lower overall survival

March 24, 2020

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The published results showed lower overall survival in pediatric, adolescent and young adult patients with soft tissue sarcoma who had low-income public insurance compared to patients with private insurance.

Lena E. Winestone

Using the University of California San Francisco Cancer Registry, Lena E. Winestone, MD, and colleagues analyzed the influence of low-income public health insurance on the overall survival of 1,106 patients aged 0 to 39 years diagnosed with bone or soft tissue sarcomas between 2000 and 2015. Researchers have defined low-income patients as those without insurance or Medicaid. The researchers used the Kaplan-Meier method to calculate survival curves, which were compared using log-rank tests and Cox models. They also assessed whether the association between public insurance and mortality was mediated by metastatic disease using causal mediation.

The results showed that 39% of patients had low-income public insurance. The researchers found that a higher proportion of patients with low-income public insurance were from racial / ethnic minorities and had metastatic disease. The researchers also noted significantly worse 5-year overall survival in patients with low-income public insurance (61%) compared to patients with private insurance (71%). Likewise, patients with low-income public insurance had a 10-year overall survival rate of 49% compared to 63% in patients with private insurance, according to the results. Patients with low-income public insurance versus private insurance had significantly worse overall survival when stratified by disease extent, including localized disease (78% vs. 84%), regional disease (64% vs. 73%) and metastatic disease (23% vs. 30%), the researchers found.

The results showed that independent predictors of overall survival included age at diagnosis and extent of disease at diagnosis. According to the results of the mediated analysis, metastatic disease at the time of diagnosis mediates 15% of the effect of public insurance on overall survival.

Pediatric patients with bone or soft tissue sarcomas who had low-income public insurance had lower overall survival rates than patients with private insurance at 5 and 10 years.

Pediatric patients with bone or soft tissue sarcomas who had low-income public insurance had lower overall survival rates than patients with private insurance at 5 and 10 years.

“In addition to the known biological predictors of sarcoma prognosis, non-biological factors also have an impact on survival. The type of insurance represents much more than the simple mode of reimbursement of care; it is an indicator of socio-economic status and individual resources, as well as a measure of access to non-cancer and cancer care, ”Winestone told Healio Orthopedics. “A more in-depth examination of other social determinants of health that may be linked to insured status is essential to understand the mechanism of this disparity and to develop interventions to improve the disparities in survival that we describe in this study. “- by Casey Tingle

Disclosures: Winestone does not report any relevant financial information. Please see the study for relevant financial information from all other authors.

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