Purpose:We investigated care disparities and associated factors along the segments of adult musculoskeletal tumor (MST) care prior to initiation of treatment.Patients and Methods:This cohort included newly diagnosed MST patients who were referred to Stanford Medical Center for establishing care from July 2020 to April 2024. We investigated the interval from the onset of symptoms to the first appointment with a primary care provider (PCP wait-time), and the interval from first PCP appointment to obtaining the first imaging study (imaging wait-time) and to obtaining biopsy results (biopsy wait-time). Sarcoma consult wait-time was defined as the interval between referral date and consult date. We performed a survey among sarcoma physicians and non-physician staff on the perception of wait-time.Results:Among 402 eligible patients, approximately 38.5% had PCP a wait-time longer than 5 weeks, with young adults and Hispanic patients having the highest rate of such long wait-times. Approximately 20.6% of patients had an imaging wait-time longer than 5 weeks, with young adults having the highest proportion of such long wait-times. In addition, Hispanic (p= 0.02), Black (p= 0.05) and Caucasian (p= 0.02) patients had significantly higher percentages of patients with an imaging wait-time of more than 5 weeks compared to Asians. Approximately 79.3% of patients had a biopsy wait-time longer than 5 weeks, with Black and Hispanic patients having the highest percent of such long wait-times. In addition, compared to public insurance, private insurance was associated with a higher proportion of patients with PCP wait-times, imaging wait-times, sarcoma consult wait-times and biopsy wait-times longer than 5 weeks. The survey responses overwhelmingly indicated that a wait-time of more than 5 weeks was not acceptable.Conclusions:Substantial disparities in MST care related to age group, ethnicity and insurance type existed in multiple segments of the care journey prior to the initiation of treatment. Our study provides insights for practice, research and policy considerations for narrowing sarcoma care disparities.
目的：本研究旨在探讨成人肌肉骨骼肿瘤（MST）患者在治疗启动前各诊疗环节中存在的医疗差异及其相关因素。 患者与方法：本队列纳入2020年7月至2024年4月期间转诊至斯坦福医学中心建立诊疗关系的新确诊MST患者。我们分析了从症状出现至首次初级保健医生（PCP）就诊的间隔时间（PCP等待时间）、从首次PCP就诊至首次影像学检查的间隔时间（影像等待时间），以及至获取活检结果的间隔时间（活检等待时间）。肉瘤专科会诊等待时间定义为转诊日期与会诊日期之间的间隔。我们对肉瘤专科医师及非医师工作人员开展了关于等待时间认知的问卷调查。 结果：在402例符合条件患者中，约38.5%的患者PCP等待时间超过5周，其中青年患者和西班牙裔患者出现此类长等待时间的比例最高。约20.6%的患者影像等待时间超过5周，青年患者在此类长等待时间中占比最高。此外，与亚裔患者相比，西班牙裔（p=0.02）、黑人（p=0.05）和白人（p=0.02）患者影像等待时间超过5周的比例显著更高。约79.3%的患者活检等待时间超过5周，黑人和西班牙裔患者在此类长等待时间中占比最高。与公共医疗保险相比，商业医疗保险与更高比例的PCP等待时间、影像等待时间、肉瘤会诊等待时间及活检等待时间超过5周显著相关。问卷调查结果压倒性地表明，超过5周的等待时间是不可接受的。 结论：在治疗启动前的多个诊疗环节中，肌肉骨骼肿瘤医疗存在与年龄组、种族和保险类型相关的显著差异。本研究为缩小肉瘤医疗差异的临床实践、研究及政策制定提供了重要参考依据。
肿瘤(癌症)患者之家