March 24, 2020
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Pediatric patients with soft tissue sarcoma, public insurance may have lower overall survival

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Published results showed inferior overall survival among 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 how low-income public health insurance influenced overall survival among 1,106 patients aged 0 to 39 years diagnosed with bone or soft tissue sarcomas between 2000 and 2015. Researchers defined low-income patients as those with no insurance or Medicaid. Researchers used the Kaplan-Meier method to compute 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.

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

Results showed independent predictors of overall survival included age at diagnosis and extent of disease at diagnosis. Metastatic disease at diagnosis mediated 15% of the effect of public insurance on overall survival, according to results of the mediation analysis.

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

“In addition to known biologic predictors of prognosis in sarcoma, non-biologic factors impact survival as well. Insurance type represents far more than simply how care is reimbursed; it is a proxy for socioeconomic status and individual resources, as well as a measure of access to non-cancer and cancer care,” Winestone told Healio Orthopedics. “A deeper look at the other social determinants of health that may be related to insurance status is essential for understanding the mechanism of this disparity and developing interventions to ameliorate the survival disparities we describe in this study.” – by Casey Tingle

 

Disclosures: Winestone reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.