Socioeconomic disparities in palliative care utilization among children with late-stage bone and soft tissue sarcomas: A National Cancer Database analysis.

Abstract

12066 Background: Palliative care seeks to improve the quality of life for many children living with cancer, but it remains underused. Racial and socioeconomic disparities have been identified in the receipt of palliative care among adult patients with advanced soft-tissue sarcomas and metastatic renal cell carcinoma. Our study seeks to determine if similar barriers exist in palliative care receipt among pediatric patients with late-stage bone and soft tissue sarcomas. Methods: We used the National Cancer Database (NCDB) to perform a retrospective review of children aged 0-25 with Stages III and IV bone and soft tissue sarcomas from 2004 to 2022. We used a 1:1 propensity score matching algorithm to compare the utilization of palliative treatment by race and ethnicity and to balance potential confounding covariates. Kaplan-Meier estimation was utilized for survival analysis. Results: A total of 8,030 patients were included in this analysis. Of these patients, 375 (4.7%) received at least one form of palliative treatment, including surgery (n=31), radiation (n=99), chemotherapy (n=55), pain management (n=98), multiple modalities (n=77), and others (n=15). The median age was 16 years (IQR: 12-20). Osteosarcoma (29.2%) was most common, followed by Ewing’s sarcoma (28.1%), non-rhabdomyosarcoma soft tissue sarcoma (21.6%), and rhabdomyosarcoma (21.0%). The 5-year overall survival rate was 14.7% (95% CI 11.2%-19.3%) for patients receiving palliative care versus 44.7% (95% CI 43.6%-45.9%) for those who did not. After propensity score matching, non-Hispanic Black children were found to be less likely to receive palliative care than non-Hispanic White children (3.4% vs. 5.9%, p = 0.047). Hispanic children were also less likely to receive palliative treatment than non-Hispanic White children (2.5% vs. 5.5%, p = 0.007). Conclusions: Hispanic and Black children with sarcomas were less likely to receive palliative care compared to White children. Further research is warranted to understand the impact of other factors contributing to palliative care receipt and how they may be addressed to optimize the quality of life in sarcoma treatment in children. Post-propensity score matching univariate analysis for palliative care use by race and ethnicity. Palliative Care Utilization* RACE ETHNICITY Total (n=1286) Non-Hispanic White (n=643) Non-Hispanic Black (n=643) p-value Total (n=1418) Non-Hispanic White (n=709) Hispanic (n=709) p-value No 1226 (95.3%) 605 (94.1%) 621 (96.6%) 0.047 1361 (96.0%) 670 (94.5%) 691 (97.5%) 0.007 Yes 60 (4.7%) 38 (5.9%) 22 (3.4%) 57 (4.0%) 39 (5.5%) 18 (2.5%) *Patients were matched based on age at diagnosis, sex, insurance status, median income of county of residence, high school graduation percentages of county of residence, mean tumor size, primary tumor sjte, AJCC stage, and presence of metastases at diagnosis.