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Disparities
among patients with extremity soft-tissue
sarcomas
A new study reveals
significant racial and ethnic differences in
the treatment and survival of patients with
soft-tissue sarcomas, a rare but dangerous
cancer that begins in muscle, fat, blood
vessels or other supporting tissue of the
body.
The findings are published in
the March 1, 2008, issue of CANCER, a
peer-reviewed journal of the American Cancer
Society.
While racial and ethnic
disparities in treatment and disease
outcomes have been reported for various
cancers, this is the first study to address
disparities in extremity soft-tissue
sarcomas.
Extremity soft-tissue
sarcomas affect approximately 9,220 patients
in the United States, more than half of
which are estimated to involve an upper or
lower extremity.
Preserving limbs with surgery
is the accepted standard treatment for adult
extremity soft tissue sarcomas.
Amputation is seldom
necessary because radiation therapy, given
either before or after surgery, can
effectively preserve limbs in up to 91
percent of cases. However, the research
showed that this doesn’t always happen for
all patients.
Utilizing a database of the
National Cancer Institute, Dr. Steve R.
Martinez, a surgical oncologist with UC
Davis Cancer Center and lead author of the
study, and Dr. Anthony S. Robbins of the
California Cancer Registry, mined the
Surveillance, Epidemiology and End Results
(SEER)-Medicare database and identified
adult patients in the United States with
extremity soft-tissue sarcomas who were
diagnosed and treated between 1988 and 2003.
Eligible patients
included 4,636 whites, 663 blacks, 696
Hispanics and 411 Asians. Comparisons of
treatments and survival were then made for
each population.
The authors found that blacks
had significantly lower rates of surgeries
that would have saved their arm or leg, they
had the highest rates of amputations, and
they were the least likely to receive
additional treatments that would lead to
improved survival.
The study found when compared
with whites, blacks had a 39 percent higher
death rate related to their disease, even
when taking into account various factors
known to influence sarcoma-specific
survival.
In their analysis, the
researchers also found that Hispanics tended
to be diagnosed with extremity soft-tissue
sarcomas at a younger age than whites,
blacks, and Asians; blacks, Hispanics, and
Asians tended to have larger tumors than
whites; Asians were most likely to undergo
limb-sparing procedures, and had the lowest
rates of amputation; and Hispanics had lower
rates of limb preservation and higher rates
of amputation when compared with whites.
Martinez said that the study
does not address the reasons for the
different outcomes for patients with the
same disease, but added that his study
should be a wake-up call for physicians
treating soft-tissue sarcomas.
“We need to take a close look
at the factors that lead to worse results
for one population when compared to others,”
he said. “And we need to focus our efforts
toward improving extremity soft-tissue
sarcoma treatment and outcomes for all
patients, especially for those most at
risk.”
Article: “Racial and Ethnic
Differences in Treatment and Survival Among
Adults With Primary Extremity Soft-Tissue
Sarcoma” Steve R. Martinez, Anthony S.
Robbins, Frederick J. Meyers, Richard J.
Bold, Vijay P. Khatri and James E.
Goodnight. CANCER; Published Online: January
22, 2008 (DOI: 10.1002/cncr.23261); Print
Issue Date: March 1, 2008.