Skip to main content

Advertisement

SpringerLink
Log in

Extremity Soft Tissue Sarcoma Care in the Elderly: Insights into the Generalizability of NCI Cancer Trials

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The projected increase in older persons in the United States, their underrepresentation in clinical trials, and the rarity of extremity soft tissue sarcomas (ESTS) limit our understanding of ESTS care in the elderly. We explored the extent of older age (≥65 years) on patterns of ESTS care in NCI-sponsored population-based dataset.

Materials and Methods

Using the 1991–2006 Surveillance Epidemiology and End Results registries, we identified 2586 Medicare aged persons ≥65 years with ESTS. We compared demographics, tumors, and treatments by age category. Multivariable analyses were used to examine the effect of older age on ESTS care and survival, adjusting for covariates.

Results

More than 30% of adult ESTS were diagnosed in patients older than 65 years. A significant trend was observed between increasing age and decreased use of sarcoma-directed surgery and delivery of radiotherapy after limb-sparing surgery for high-grade or T2 tumors. Limb amputation rates did not vary by age. However, both African-American (odds ratio [OR] 1.85, 95% confidence interval [95% CI] 1.05–3.27, P = .0341) and Hispanic races (OR 2.17, 95% CI 1.27–3.70, P = .0044) predicted higher rates of limb amputation than whites. Although our multivariable analyses showed that decreased use of sarcoma-directed surgery was only limited to age 85 + years, it also showed that older age predicted poorer cancer-specific mortality following sarcoma-directed surgery (P < .0001).

Conclusions

In this US population-based study, the decreased use of sarcoma-directed surgery in the elderly was only limited to those older than 85 years. The association between older age and increased cancer-related mortality deserves future investigation to carefully examine potential effects of undertreatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66.

    Article  PubMed  Google Scholar 

  2. Lahat G, Lazar A, Lev D. Sarcoma epidemiology and etiology: potential environmental and genetic factors. Surg Clin North Am. 2008;88:451–81, v.

    Google Scholar 

  3. Clark MA, Fisher C, Judson I, Thomas JM. Soft-tissue sarcomas in adults. N Engl J Med. 2005;353:701–11.

    Article  CAS  PubMed  Google Scholar 

  4. Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14:1679–89.

    CAS  PubMed  Google Scholar 

  5. Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol. 2002;20:791–6.

    Article  PubMed  Google Scholar 

  6. Eilber FC, Brennan MF, Eilber FR, Dry SM, Singer S, Kattan MW. Validation of the postoperative nomogram for 12-year sarcoma-specific mortality. Cancer. 2004;101:2270–5.

    Article  PubMed  Google Scholar 

  7. Pisters PW, Pollock RE, Lewis VO, Yasko AW, Cormier JN, Respondek PM, et al. Long-term results of prospective trial of surgery alone with selective use of radiation for patients with T1 extremity and trunk soft tissue sarcomas. Ann Surg. 2007;246:675–81; (discussion 681–2).

    Article  PubMed  Google Scholar 

  8. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.

    Article  PubMed  Google Scholar 

  9. Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970–2002. JAMA. 2005;294:1255–9.

    Article  CAS  PubMed  Google Scholar 

  10. Boden RA, Clark MA, Neuhaus SJ, A’Hern J R, Thomas JM, Hayes AJ. Surgical management of soft tissue sarcoma in patients over 80 years. Eur J Surg Oncol. 2006;32:1154–8.

    Article  CAS  PubMed  Google Scholar 

  11. Buchner M, Bernd L, Zahlten-Hinguranage A, Sabo D. Primary malignant tumours of bone and soft tissue in the elderly. Eur J Surg Oncol. 2004;30:877–83.

    Article  CAS  PubMed  Google Scholar 

  12. Osaka S, Sugita H, Osaka E, Yoshida Y, Ryu J. Surgical management of malignant soft tissue tumours in patients aged 65 years or older. J Orthop Surg. 2003;11:28–33.

    CAS  Google Scholar 

  13. Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14:859–68.

    CAS  PubMed  Google Scholar 

  14. Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.

    CAS  PubMed  Google Scholar 

  15. Hutchins LF, Unger JM, Crowley JJ, Coltman CA, Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.

    Article  CAS  PubMed  Google Scholar 

  16. Stewart JH, Bertoni AG, Staten JL, Levine EA, Gross CP. Participation in surgical oncology clinical trials: gender-, race/ethnicity-, and age-based disparities. Ann Surg Oncol. 2007;14:3328–34.

    Article  PubMed  Google Scholar 

  17. Adam DJ, Craig SR, Sang CT, Cameron EW, Walker WS. Esophagectomy for carcinoma in the octogenarian. Ann Thorac Surg. 1996;61:190–4.

    Article  CAS  PubMed  Google Scholar 

  18. Lahat G, Dhuka AR, Lahat S, Lazar AJ, Lewis VO, Lin PP, et al. Complete soft tissue sarcoma resection is a viable treatment option for select elderly patients. Ann Surg Oncol. 2009;16:2579–86.

    Article  CAS  PubMed  Google Scholar 

  19. Martinez SR, Robbins AS, Meyers FJ, Bold RJ, Khatri VP, Goodnight JE, Jr. Racial and ethnic differences in treatment and survival among adults with primary extremity soft-tissue sarcoma. Cancer. 2008;112:1162–8.

    Article  PubMed  Google Scholar 

  20. Esnaola NF, Hall BL, Hosokawa PW, Ayanian JZ, Henderson WG, Khuri SF, et al. Race and surgical outcomes: it is not all black and white. Ann Surg. 2008;248:647–55.

    PubMed  Google Scholar 

  21. Meropol NJ, Schrag D, Smith TJ, Mulvey TM, Langdon RM Jr, Blum D, et al. American Society of Clinical Oncology guidance statement: the cost of cancer care. J Clin Oncol. 2009;27:3868–74.

    Article  PubMed  Google Scholar 

  22. Yabroff KR, Lamont EB, Mariotto A, Warren JL, Topor M, Meekins A, et al. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst. 2008;100:630–41.

    Article  PubMed  Google Scholar 

  23. Warren JL, Yabroff KR, Meekins A, Topor M, Lamont EB, Brown ML. Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst. 2008;100:888–97.

    Article  PubMed  Google Scholar 

  24. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA. 2004;291:2720–6.

    Article  CAS  PubMed  Google Scholar 

  25. Newman LA, Hurd T, Leitch M, Kuerer HM, Diehl K, Lucci A, et al. A report on accrual rates for elderly and minority-ethnicity cancer patients to clinical trials of the American College of Surgeons Oncology Group. J Am Coll Surg. 2004;199:644–51.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Supported by The 2008 Veterans of Foreign Wars and Ladies Cancer Research Center Endowment Fund.

Financial disclosures and conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Minnesota, Minneapolis and Minneapolis VAMC, Minneapolis, MN, USA

    Waddah B. Al-Refaie MD, FACS

  2. Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Elizabeth B. Habermann MPH, PhD, Vikas Dudeja MD, Selwyn M. Vickers MD, FACS, Todd M. Tuttle MD, FACS, MS & Eric H. Jensen MD

  3. Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA

    Beth A. Virnig MPH, PhD

Authors
  1. Waddah B. Al-Refaie MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth B. Habermann MPH, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vikas Dudeja MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Selwyn M. Vickers MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Todd M. Tuttle MD, FACS, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric H. Jensen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Beth A. Virnig MPH, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Waddah B. Al-Refaie MD, FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Al-Refaie, W.B., Habermann, E.B., Dudeja, V. et al. Extremity Soft Tissue Sarcoma Care in the Elderly: Insights into the Generalizability of NCI Cancer Trials. Ann Surg Oncol 17, 1732–1738 (2010). https://doi.org/10.1245/s10434-010-1034-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-1034-z

Keywords

Search

Navigation