Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma

Mark A. Kashtan, Thejus T. Jayakrishnan, Rahul Rajeev, John C. Charlson, Fabian Johnston, T. Clark Gamblin, Kiran K. Turaga

Research output: Contribution to journalArticle

Abstract

Background: Elderly patients (EPs) suffering from retroperitoneal rhabdomyosarcoma (RRMS) carry a considerably poorer prognosis compared to younger patients (YPs). We hypothesized that EPs received less aggressive and comprehensive treatment than YPs, resulting in poorer survival outcomes. Materials and methods: All patients diagnosed with RRMS since 1998 in the National Cancer Data Base (NCDB) were reviewed for patient demographics, tumor characteristics, treatment modalities and survival outcomes. Results: Of the 100 patients identified, 35 % were ≥65 years of age. EPs (aged ≥65 years), when compared to YPs (aged <65), were less likely to receive systemic chemotherapy (20 % EPs vs 71 % YPs, p < 0.001) and treatment at an academic center (34 % EPs vs 60 % YPs, p = 0.05), although the frequency of radiation (23 % EPs vs 31 % YPs, p = 0.40) and radical surgery (26 % EPs vs 22 % YPs, p = 0.55) were similar. EPs received treatment more frequently at comprehensive community cancer programs (57 %) and had a shorter median distance of travel for care (6.4 vs 13 miles, p = 0.009). After adjusting for gender and tumor size, EPs had a hazard ratio of 3.6 (95 % CI 1.8–7.2, p < 0.001), with a median survival of 2 months (interquartile range [IQR] 1–8 months) versus 17 months for YPs (IQR 8–43 months). Conclusion: Altered practice patterns exist for EPs and include reduced use of systemic chemotherapy which may contribute to poorer outcomes for RRMS patients. Although regionalization of care poses challenges, this may offer benefit to the EP group.

Original languageEnglish (US)
Pages (from-to)602-608
Number of pages7
JournalInternational Journal of Clinical Oncology
Volume21
Issue number3
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

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Rhabdomyosarcoma
Survival
Neoplasms

Keywords

  • Disparities
  • Elderly
  • Retroperitoneal
  • Rhabdomyosarcoma
  • Sarcoma

ASJC Scopus subject areas

  • Surgery
  • Hematology
  • Oncology

Cite this

Kashtan, M. A., Jayakrishnan, T. T., Rajeev, R., Charlson, J. C., Johnston, F., Clark Gamblin, T., & Turaga, K. K. (2016). Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma. International Journal of Clinical Oncology, 21(3), 602-608. https://doi.org/10.1007/s10147-015-0918-0

Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma. / Kashtan, Mark A.; Jayakrishnan, Thejus T.; Rajeev, Rahul; Charlson, John C.; Johnston, Fabian; Clark Gamblin, T.; Turaga, Kiran K.

In: International Journal of Clinical Oncology, Vol. 21, No. 3, 01.06.2016, p. 602-608.

Research output: Contribution to journalArticle

Kashtan, MA, Jayakrishnan, TT, Rajeev, R, Charlson, JC, Johnston, F, Clark Gamblin, T & Turaga, KK 2016, 'Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma', International Journal of Clinical Oncology, vol. 21, no. 3, pp. 602-608. https://doi.org/10.1007/s10147-015-0918-0
Kashtan, Mark A. ; Jayakrishnan, Thejus T. ; Rajeev, Rahul ; Charlson, John C. ; Johnston, Fabian ; Clark Gamblin, T. ; Turaga, Kiran K. / Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma. In: International Journal of Clinical Oncology. 2016 ; Vol. 21, No. 3. pp. 602-608.
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abstract = "Background: Elderly patients (EPs) suffering from retroperitoneal rhabdomyosarcoma (RRMS) carry a considerably poorer prognosis compared to younger patients (YPs). We hypothesized that EPs received less aggressive and comprehensive treatment than YPs, resulting in poorer survival outcomes. Materials and methods: All patients diagnosed with RRMS since 1998 in the National Cancer Data Base (NCDB) were reviewed for patient demographics, tumor characteristics, treatment modalities and survival outcomes. Results: Of the 100 patients identified, 35 {\%} were ≥65 years of age. EPs (aged ≥65 years), when compared to YPs (aged <65), were less likely to receive systemic chemotherapy (20 {\%} EPs vs 71 {\%} YPs, p < 0.001) and treatment at an academic center (34 {\%} EPs vs 60 {\%} YPs, p = 0.05), although the frequency of radiation (23 {\%} EPs vs 31 {\%} YPs, p = 0.40) and radical surgery (26 {\%} EPs vs 22 {\%} YPs, p = 0.55) were similar. EPs received treatment more frequently at comprehensive community cancer programs (57 {\%}) and had a shorter median distance of travel for care (6.4 vs 13 miles, p = 0.009). After adjusting for gender and tumor size, EPs had a hazard ratio of 3.6 (95 {\%} CI 1.8–7.2, p < 0.001), with a median survival of 2 months (interquartile range [IQR] 1–8 months) versus 17 months for YPs (IQR 8–43 months). Conclusion: Altered practice patterns exist for EPs and include reduced use of systemic chemotherapy which may contribute to poorer outcomes for RRMS patients. Although regionalization of care poses challenges, this may offer benefit to the EP group.",
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AU - Charlson, John C.

AU - Johnston, Fabian

AU - Clark Gamblin, T.

AU - Turaga, Kiran K.

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