Income and Insurance-Based Disparities in Primary Soft Tissue Sarcoma of the Extremities

Abstract

Background and Objectives

Soft tissue sarcomas (STSs) are rare but can be devastating. Paradigm shifts in adjuvant treatment have expanded the availability of limb salvage; however, a subset of patients still require amputation. The aim of this study was to examine the impact of patient, disease, and practice-related factors on rates of amputation in STS.

Methods

All adults undergoing resection for STS of the extremities were tabulated from the 2004–2021 National Cancer Database (NCDB). Multivariable models were utilized to evaluate risk factors for undergoing amputation.

Results

Of 31 805 patients, 1880 (6%) underwent amputation. Those who underwent amputation were younger (57 vs. 60, p < 0.001), more commonly Black (12% vs. 9%, p < 0.00), and more frequently Medicaid insured (11% vs. 6%, p < 0.001). Amputation patients experienced a longer time from diagnosis to surgery, compared to limb salvage patients (46 [23–91] vs. 37 days [9–93], p < 0.001). Amputation was associated with a significantly greater hazard of overall mortality over 10 years following resection (HR 1.66, p < 0.001).

Conclusion

We report significant race-, income-, and insurance-based disparities in amputation risk and overall survival for patients with STS of the extremities. We also report a significantly increased risk of amputation for patients with delayed clinical presentation. Multidisciplinary sarcoma care teams should be aware of these disparities.