Impact of fragmented care on retroperitoneal sarcomas

BACKGROUND: Fragmented care (FC) is associated with mixed outcomes. This analysis examines FC's impact on retroperitoneal sarcoma (RPS) treatment.

METHODS: The National Cancer Database was queried for adult patients with non-metastatic, surgically-resected RPS. FC was defined as diagnosis/treatment at >1 facility. Univariable and multivariable analyses examined factors associated with FC and its impact on overall survival.

RESULTS: 4976 patients were included; 45.6 ​% experienced FC. Non-FC and FC cohorts were similar. Dedifferentiated liposarcoma were more common in FC cohort, as were poorly differentiated and undifferentiated tumors (p ​< ​0.05). FC cohort had greater travel distance and time-to-treatment (both p ​< ​0.001). Variables independently associated with FC included urban and rural setting and histology (poorly differentiated and undifferentiated) (all p ​< ​0.05). After controlling for other variables, FC was not associated with survival.

CONCLUSION: FC patients experienced longer distance travelled and time-to-treatment without survival impact. National emphasis must be placed on broadening access to equitable, high-quality sarcoma care.