Patients in ‘very rural’ areas with osteosarcoma at greater risk of mortality than patients in urban areas

LAS VEGAS — Results on patients with osteosarcoma presented at the American Academy of Orthopaedic Surgeons Annual Meeting concluded that distance and travel to the nearest treatment center had a moderate risk on the presence of metastasis presentation and found metastasis was the main driver for mortality. Rural patients were not at a significantly higher mortality risk after controlling metastasis and tumor size, but patients categorized as “very rural” were.

“Our conclusion was that distance and time showed moderate effect on the presence of [metastasis] presentation, and then [we found] the presence of [metastasis] as the primary variable of mortality; but the patient’s rural status is a risk factor for mortality, even when controlling for [metastasis],” Ryan Wendt, a third-year medical student at the University of Iowa, said in his presentation.

Wendt and his team observed patients who lived in rural counties or those who lived at greater distances to comprehensive cancer centers to find if they presented at higher stages, had larger tumors or had a low overall survival rate due to these factors. The investigators used the Surveillance Epidemiology and End Results Program Database, which represents about a 25% of the U.S. population, according to Wendt.

A continuum code within the database was used to designate counties based on rural and urban locations. Using the code, Wendt and his team further divided the counties for analysis. They considered a patient to be “very rural” if they lived in a rural county and their county was not next to an urban county. They searched for patients with osteosarcoma, high-grade osteosarcoma, extremity or exoskeleton osteosarcoma diagnosed between 1990 and 2014 in Mexico, Utah and Iowa. Overall, there were 476 patients. Outcomes of their research included tumor size at presentation, metastases at presentation and 5-year disease-specific survival.

Overall, research showed rural patients were at an increased rate for mortality, especially within the very rural group. Metastasis was the primary driver for mortality in both groups studied, but the very rural patients had a hazard ratio of 1.58 after researchers controlled for metastasis and tumor size. – by Amanda Palma

Reference:

Wendt R, et al. Abstract 492. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 12-16, 2019; Las Vegas.

Disclosure: Wendt reports no relevant financial disclosures.