Abstract 5280: Disparity-related survival among adolescent and young adult patients with sarcomas in Texas

Abstract

Abstract Purpose: Sarcomas are a rare and heterogeneous group of cancers that can occur in both children and adults, and have a peak in incidence in adolescents and young adults (AYAs). Sarcomas may account for ~10% of all invasive cancers among AYAs and >50% of all sarcoma diagnoses occur in this age group. Additionally, sarcoma survival among AYAs is lower than that in children or adult patients. Furthermore, although less understood, significant socioeconomic disparities may exist in survival among AYAs with sarcomas. The current project examines disparity-related survival among AYAs with sarcoma in Texas, one of the largest U.S. states, that has over 50% non-Hispanic white population. Methods: N=4,131 patients diagnosed with bone or soft tissue sarcomas were identified in the statewide Texas Cancer Registry from 1995-2013 at ages 15-39 years (i.e., AYA age range). Socio-demographics at diagnosis (e.g., race and ethnicity, insurance, and county of residence), clinical characteristics (e.g., early vs. late stage, treatment (e.g., chemotherapy), and vital status as of December 31, 2013) were summarized. Associations between patient survival and demographics/clinical variables were examined using the Kaplan Meier (KM) method, and the Cox Proportional Hazard (CPH) regressions. KM survival curves were compared using log-rank tests. Results: Over half of our patients were male (57.4%). 36.6% were Hispanic, 12.7% were non-Hispanic black, and 46.6% were non-Hispanic white. Nearly 22% of patients were uninsured. Furthermore, 20% of patients were diagnosed with metastatic sarcoma. The average 5-year KM survival for all patients was 69.5% (95% CI=67.9%-71.0%). KM survival curves significantly differed by variables such as sex, race and ethnicity, insurance and tumor staging. KM 5-year survival was higher for females (73.7% vs. 66.1% for males, p<0.001), for non-Hispanic white patients (72.1% vs. 63.9% for non-Hispanic blacks, p<0.001), patients with private insurance (76.0% vs. 68.2% for uninsured, p<0.001), and those with early stage sarcomas (77.1% vs. 23.4%, p<0.001). After adjusting for treatment and tumor staging, the CPH model demonstrated that males (hazard ratio (HR)=1.93, 95% CI=1.25-3.00, p=0.003) and those who resided in Texas counties bordering Mexico (HR=1.95, 95%CI=1.04-3.67, p=0.04) faced a significantly higher risk of death than their counterparts. Conclusion: Our population-based analyses show that substantial disparity-related differences in survival exist among AYA sarcoma patients in Texas. Further study is warranted to identify specific interventions to improve survival outcomes in this high risk patient group. Citation Format: Jaqueline Contrera Avila, J. Andrew Livingston, Ana Rodriguez, Anne Kirchhoff, Yong-Fang Kuo, Sapna Kaul. Disparity-related survival among adolescent and young adult patients with sarcomas in Texas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5280. doi:10.1158/1538-7445.AM2017-5280