Saturday, January 26, 2008

Why Radiation is Important....

For all Sarcoma patients after limb-sparing surgery. Sadly, Black patients don't seem to be getting the treatment they need. Interesting findings in a recent study... Listen in too

Racial Disparities Seen in Sarcoma Treatment and Outcomes

SACRAMENTO, Calif., Jan. 22 -- Outcomes and treatment for patients with extremity soft-tissue sarcoma vary significantly by race and ethnicity, investigators here found.

Black patients had a 39% decrement in disease-specific survival compared with other groups and Asian patients had a 33% improvement, Steve R. Martinez, M.D., of the University of California Davis, and colleagues reported online in advance of the March 1 issue of Cancer.

Blacks also were significantly less likely compared with whites to be given adjuvant radiation with limb-sparing surgery. Hispanic patients had a 24% decrement in the rate of limb-sparing surgery compared with other groups.Action Points
Explain to interested patients that race and ethnicity appear to influence the treatment and survival in extremity soft-tissue sarcomas.

Note that the reasons for the disparities could not be determined by this study.
Disparities in treatment and outcomes have been reported previously for several malignancies, but not extremity soft-tissue sarcoma. "These disparities were not explained by differences in patient or tumor characteristics," the authors concluded.

"We believe that these differences probably are multifactorial," they added. "The identification of racial/ethnic differences should serve to focus our efforts toward improving [extremity soft-tissue sarcoma] treatment and outcomes for all patients, especially those most at risk."

An estimated 9,220 cases of soft-tissue sarcoma were diagnosed in 2007, half involving an upper or lower extremity, the authors said. Limb preservation is preferred to amputation and remains the standard of care for extremity soft-tissue sarcoma.

Only about 5% of patients require amputation because of anatomic issues, the authors continued. Radiation therapy, either before or after surgery, has dramatically improved outcomes, providing effective local control for as many as 91% of patients.

The authors reviewed the Surveillance, Epidemiology, and End Results (SEER) database and identified 6,406 adults with extremity soft-tissue sarcoma diagnosed and treated from 1988 to 2003. The patients were separated into four racial/ethnic groups: whites (N=4,636), blacks (N=663), Hispanics (N=696), and Asians (N=411).

Treatment and disease-specific survival were analyzed in logistic regression models that controlled for patient age, sex, SEER geographic region, extent of disease, tumor grade, tumor size, and histology.

The analysis revealed significant differences in patient and tumor characteristics. Black and Hispanic patients were younger than Caucasians and Asians (P0.001). Whites were less likely to have large tumors (≥5 cm) compared with the other groups (P0.001). Blacks also had a higher proportion of tumors that were undifferentiated/anaplastic or of unknown grade (P=0.003).

Hispanic patients were significantly less likely to receive any form of limb-sparing surgery (odds ratio: 0.76, 95% CI: 0.59 to 0.97). Blacks were significantly less likely than the other groups to have both surgical resection and adjuvant radiation (OR: 0.77, 95% CI: 0.66 to 0.90).

The analysis showed that adjuvant radiation was underused, irrespective of racial/ethnic group. The proportion of patients given both surgery and adjuvant radiation ranged from 39.5% in blacks to 48.7% in Asians. Overall, 46.3% of patients were given adjuvant radiation.

"We were really surprised by the overall low rate of adjuvant radiation," Dr. Martinez said in an interview. "Limb-sparing surgery plus adjuvant radiation has been the standard of care for quite awhile. We could not tell from this dataset why so few patients received adjuvant radiation."

Blacks had the highest five-year mortality (18.4%), followed by whites (13.6%), Hispanics (11.7%), and Asians (9.4%). The differences translated into a 39% excess mortality risk in blacks (95% CI: 1.13 to 1.70) and a 33% reduction in mortality risk among Asian patients (95% CI: 0.46 to 0.97).

As to limitations of the study, the authors noted that they excluded cases before 1988, even though surgery and adjuvant radiation had already been established as the standard of care. The authors lacked good information about the appropriateness or adequacy of treatment that patients received. They also did not have information about patients' socioeconomic status, which can have a substantive effect on treatment and outcomes.

The authors reported no disclosures.

Primary source: Cancer
Source reference:
Martinez SR, et al "Racial and ethnic differences in treatment and survival among adults with primary extremity soft-tissue sarcoma"Cancer. 2008; 112: DOI: 10.1002/cncr23261.

1 comment:

Doctor David said...

This was a very important article! I'm glad you brought it to the attention of your readers. We always need to keep this sort of thing in mind, and work hard to be sure that EVERYONE gets the best possible care, no matter who or where they are!