Racial differences in extremity soft tissue sarcoma treatment in a universally insured population

Authors

Linda M. Pak, Harvard Medical School, Boston
Nicollette K. Kwon, Brigham and Women's Hospital, Boston
Elizabeth H. Baldini, Harvard Medical School, Boston
Peter A. Learn, Uniformed Services University of the Health Sciences, Bethesda
Tracey Koehlmoos, Uniformed Services University of the Health Sciences, Bethesda
Adil H. Haider, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, BostonFollow
Chandrajit P. Raut, Harvard Medical School, Boston

Document Type

Article

Department

General Surgery

Abstract

Background: In prior reports from population-based databases, black patients with extremity soft tissue sarcoma (ESTS) have lower reported rates of limb-sparing surgery and adjuvant treatment. The objective of this study was to compare the multimodality treatment of ESTS between black and white patients within a universally insured and equal-access health care system.
Methods: Claims data from TRICARE, the US Department of Defense insurance plan that provides health care coverage for 9 million active-duty personnel, retirees, and dependents, were queried for patients younger than 65 y with ESTS who underwent limb-sparing surgery or amputation between 2006 and 2014 and identified as black or white race. Multivariable logistic regression analysis was used to evaluate the impact of race on the utilization of surgery, chemotherapy, and radiation.
Results: Of the 719 patients included for analysis, 605 patients (84%) were white and 114 (16%) were black. Compared with whites, blacks had the same likelihood of receiving limb-sparing surgery (odds ratio [OR], 0.861; 95% confidence interval [95% CI], 0.284-2.611; P = 0.79), neoadjuvant radiation (OR, 1.177; 95% CI, 0.204-1.319; P = 0.34), and neoadjuvant (OR, 0.852; 95% CI, 0.554-1.311; P = 0.47) and adjuvant (OR, 1.211; 95% CI, 0.911-1.611; P = 0.19) chemotherapy; blacks more likely to receive adjuvant radiation (OR, 1.917; 95% CI, 1.162-3.162; P = 0.011).
Conclusions: In a universally insured population, racial differences in the rates of limb-sparing surgery for ESTS are significantly mitigated compared with prior reports. Biologic or disease factors that could not be accounted for in this study may contribute to the increased use of adjuvant radiation among black patients.

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Journal of Surgical Research

Recommended Citation

Pak, L. M., Kwon, N. K., Baldini, E. H., Learn, P. A., Koehlmoos, T., Haider, A. H., Raut, C. P. (2020). Racial differences in extremity soft tissue sarcoma treatment in a universally insured population. Journal of Surgical Research, 250, 125-134.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/183