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.