P. Phan2, C. Chidiac1, D. Rhee1 1The Johns Hopkins University School Of Medicine, Division Of Pediatric Surgery, Baltimore, MD, USA 2The Johns Hopkins University School Of Medicine, Baltimore, MD, USA
Introduction: Treatment for sarcoma is complex and requires expertise from many specialties. Institutions develop multidisciplinary teams to provide optimal comprehensive care in a coordinated fashion, however many patients receive treatment across multiple centers, potentially leading to disjointed care or treatment delays. Our study seeks to determine whether sarcoma patients who receive care at multiple centers have worse outcomes compared to those who receive all their treatment at only one center.
Methods: We performed a retrospective review of all patients with bone and soft tissue sarcomas from 2004-2020, using the National Cancer Database (NCDB). We compared the overall survival for patients receiving treatment at one center to those who received treatment at multiple centers using Kaplan-Meier survival curves and multivariate Cox hazard regressions. Patients were also subdivided by age groups, pediatric (<18), young adult (18-39), and older adult (≥40), and by the number of treatment modalities they received (surgery, radiation, and chemotherapy).
Results: 79,992 patients were included in our study. 29,452 (36.8%) received care at multiple centers while 50,540 (63.2%) were treated at only one center. The median age was 50 years (IQR: 23-67) and included Ewing’s sarcomas (5.4%), non-rhabdomyosarcoma soft tissue sarcomas (77.4%), osteosarcomas (9.6%), and rhabdomyosarcomas (7.6%). The 5-year overall survival rate was 55% (95% CI 55%-56%) and 60% (95% CI 60%-61%) for patients receiving care at one and multiple centers, respectively. After adjusting for age, sex, race, cancer type, tumor size, and metastasis, the risk of death was 17% higher (HR 1.17, 95% CI 1.14-1.21, p<0.001) in older adult patients treated at one center compared to multiple. In children and young adults, there was no difference in risk found. For patients receiving one treatment modality, there was a 6% increased risk of death for patients treated at one center, but those who received two or more had no difference in risk between the number of centers. Patients treated at one center were more likely not to initiate surgery (2.2% vs. 0.6%, p<0.001) or radiation (5.8% vs. 1.7%, p<0.001) as recommended and had greater rates of discontinued radiation (2.9% vs. 2.0%, p<0.001) and unplanned readmissions (2.3% vs. 1.0%, p<0.001).
Conclusion: Older adults treated at one center for bone and soft tissue sarcomas may be associated with worse outcomes compared to those treated at multiple centers. There does not appear to be an association between the number of centers and survival in children and young adults. Further research is warranted to understand how coordination of care among treatment centers affects outcomes in sarcoma treatment.
