Dr Randall on the Effect of Socioeconomic Factors in Pediatric Nonmetastatic Osteosarcoma

“Children living in poverty or of marginalized race or ethnicity experience inferior outcomes across a variety of cancers, but we don’t know about osteosarcoma. [These data are] poorly defined. This study looked at the differences in race [and] ethnicity, and we proxied poverty exposure to look at event-free survival [EFS] for children with nonmetastatic osteosarcoma.”

R. Lor Randall, MD, FACS, David Linn Endowed Chair for Orthopedic Surgery, chair, Department of Orthopaedic Surgery, professor, the University of California, Davis, highlights findings from a retrospective cohort study on the effect of socioeconomic factors, race, and ethnicity on outcomes in pediatric patients with nonmetastatic osteosarcoma, based on patients enrolled and treated in the phase 3 AOST0331/EURAMOS-1 trial (NCT00134030) conducted by the Children's Oncology Group (COG).

In the retrospective cohort analysis, investigators examined 758 patients with nonmetastatic osteosarcoma between the ages of 5 and 21 who were enrolled in the AOST0331/EURAMOS-1 trial. The retrospective analysis aimed to evaluate the influence of poverty, race, and ethnicity on survival outcomes. In this population, 25.6% of patients and 28.5% of patients were exposed to household poverty and neighborhood poverty, respectively. Twenty-one percent of patients identified as Hispanic, 15.4% were non-Hispanic Black, 5.3% were non-Hispanic other, and 54.0% were non-Hispanic White.

Findings showed that the 4-year post-relapse survival rates were 35.7% in Hispanic patients, 13.0% in non-Hispanic Black patients, 43.8% in non-Hispanic other patients, and 38.9% in non-Hispanic White patients (P = .0046). Notably, statistically significant differences in the risk of EFS or death were not observed based on poverty status, race, or ethnicity. Randall and colleagues did note that non-Hispanic Black patients experienced statistically significant worse outcomes regarding post-relapse survival, which prompts the need to further understand post-relapse disparities.

Frontline therapy outcomes were comparable across socioeconomic and racial groups, which Randall attributes to the comprehensive and accessible nature of pediatric oncology care within the COG framework. This outcome contrasts with adult oncology, where socioeconomic disparities often lead to more pronounced outcome differences in frontline treatment settings, he concludes.