Introduction:
Sarcomas comprise a heterogenous group of soft tissue and bony
mesenchymal tumors and account for 12-15% of pediatric cancer
diagnoses.1,2 These include soft tissue sarcomas such
as rhabdomyosarcoma (RMS) and non-rhabdomyosarcoma soft tissue sarcoma
(NRSTS), as well as bone tumors including osteosarcoma and Ewing
sarcoma. Sarcomas typically present with a mass or pain, and can arise
anywhere in the body, and as a result, can present with a wide range of
symptoms.3 Successful treatment of pediatric sarcomas
requires prompt diagnosis, multimodal therapy, multidisciplinary teams,
and specialized care centers4–7, however some
patients do not have access to high-quality care, or may not be brought
to the health system until the cancer has progressed to an advanced
stage.
Racial, ethnic, and socioeconomic status (SES) disparities in cancer
care are well-documented within the adult
population.8–12 Previous research also suggests that
racial and ethnic differences exist regarding delays in presentation and
outcomes for sarcomas in the pediatric
population.13–15 While differences in tumor biology
may exist among certain ethnic groups16,17, social and
cultural barriers also affect access to care and patient outcomes.
Insurance status, for example, is associated with survival disparities,
where uninsured and Medicaid patients are more likely to present with
advanced-staged cancer.18 This disparity has been
demonstrated across multiple cancer types, including
Hodgkin18 and non-Hodgkin lymphoma, and bladder and
thyroid cancers.19 This trend is even more prominent
in cancer types detectable with early screening such as breast
cancer20 and melanoma21, where lack
of regular medical care and preventive screening can delay diagnosis and
treatment.
Children and many AYA patients are dependent on parents and guardians
functionally and financially, increasing the complexity of studying
health disparities in this population. In addition, young adults are
often still dependent on their parents’ insurance. As a result, the
impact of SES and insurance status on the pediatric and AYA population
is less clear. The current study looks to examine the national
associations of SES and insurance status on the degree of advanced
disease at diagnosis in children and young adults with sarcoma using the
National Cancer Database.