Analysis of sarcoma outcomes at a metropolitan area safety net hospital.

Abstract

e18688 Background: Sarcomas are a group of heterogenous tumors with diverse histopathological types. They account for less than 1% of adult solid tumors (1). The estimated new cases were 13,190 with 5,130 estimated deaths in 2022(2). Survival is largely determined by presence of metastasis on diagnosis, grade, site, and size of the tumor(3). Data over 19 years in our safety net hospital were analyzed including demographic data, disease characteristics and treatment modalities in association with overall survival. Methods: All patients diagnosed with sarcoma from 1998 to 2017 were included in the analysis. Patients were categorized by insurance status, stage, site, grade, pain on presentation, and treatment modalities. Survival analysis and Kaplan-Meier curves were conducted to examine the relation between patient demographics and survival. Results: Of 163 patients included in the analysis, 54% were insured and 46% were uninsured. Uninsured patients had a higher overall survival rate compared to insured patients (HR = 0.49, CI 0.38-0.90, p = 0.014). Regarding race, 55% of patients were white, 35.6% were black and 9.2% patients were identified as other races. There was no difference in overall survival between different ethnicities. Regarding gender, 61.3% were males and 38.7% were females with no statistically significant difference in survival. Compared to stage I, stage III were 2.28 times (CI 1.27-4.08, p = 0.005) and stage IV were 5.76 times (CI 3.16-10.05, p < 0.001) more likely to die. There was no statistically significant improvement in overall survival in patients who underwent chemotherapy or radiotherapy. However, surgical intervention was associated with improved survival and patients were three times more likely to survive (0.3, CI 0.18-0.5, p < 0.001). Analysis also showed no statistically significant difference in survival in patients presenting with pain. Conclusions: Insured patients have better outcomes overall than uninsured patients in sarcomas(4). Nevertheless, within safety-net-hospitals, all patients receive necessary treatment regardless of insurance status. We found that in our institution, insurance may factor in delaying treatment due to hurdles such as prior authorizations, co-pays and coverage disruptions(5). Conversely, uninsured patients can begin appropriate treatment without such delays which could explain difference in survival rates. Additional studies are needed to identify the possible effects of insurance and pinpoint its burden on survivorship. [Table: see text]