| Description |
- Purpose
To determine the impact of race, socioeconomic deprivation, and insurance status on imaging surveillance adherence in a 5-year period after index diagnosis and surgical resection of a bone or soft tissue sarcoma at a single, large academic institution. The impact of imaging adherence, race, socioeconomic deprivation, and insurance status on cancer related mortality was also evaluated.
Methods
148 patients were identified from a single, large university hospital between 2013-2018 who underwent resection of a primary orthopedic sarcoma. Patients were included who survived for at least 5 years following resection or until the point of metastasis development. Patients with evidence of metastasis at the time of tumor resection were excluded as were patients who did not have all surveillance data available. Optimal surveillance was defined as receiving all recommended primary site and chest imaging within one month of initial scheduling for the duration of either 5 years post-surgery or until a diagnosis of metastasis. Statistical analyses were done using individual bivariate binary logistic regressions.
Results
Our final cohort consisted of 91 patients. 50% of Under-represented minorities (URMs) developed metastasis within 5 years following primary tumor excision vs 28% for White patients. 5-year survival following excision was 78% for White patients and 58% for URMs. URM status was associated with 5.26 odds of not receiving optimal imaging (P value = .01). Insurance type was not significantly associated with adherence to surveillance protocols. Though not statistically significant, having an ADI of 60 or greater was associated with 0.31 odds of obtaining optimal imaging (95% CI [0.09, 1.05] P value= 0.06). In comparison to White, URM status was associated with 3.20 odds of death during the 5-year postoperative period. 3-year survival for patients diagnosed with metastasis was 35% for White patients vs 8% for URMs.
Conclusions
Optimal surveillance imaging is critical for early metastasis detection, treatment, and ultimately survival in sarcoma patients following primary tumor resection. At our institution, URM status was associated with 5.26 odds of receiving suboptimal surveillance imaging compared to White patients. URM status was also associated with 3.2 odds of death vs being White following primary tumor excision. Because URMs are at greater risk for metastasis development, possibly due to delays in diagnosis, it is critically important for these patients to receive timely surveillance imaging. These data highlight the need to seek interventions on both a societal and health system levels to improve imaging adherence among URMs, and consider factors contributing to lower rates of survival among URMs that undergo tumor resection.
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