Li Lauren J, Bui Nam, Moding Everett J, Steffner Robert, Mohler David, Ganjoo Kristen, Pan Minggui
Department of Medicine, Division of Oncology, Stanford University, Stanford, CA 94305, USA.
Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA.
Cancers (Basel). 2025 Apr 30;17(9):1519. doi: 10.3390/cancers17091519.
We investigated care disparities and associated factors along the segments of adult musculoskeletal tumor (MST) care prior to initiation of treatment. 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. 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 ( = 0.02), Black ( = 0.05) and Caucasian ( = 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. 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.
我们在治疗开始前调查了成人肌肉骨骼肿瘤（MST）护理各环节中的护理差异及相关因素。该队列包括2020年7月至2024年4月期间被转诊至斯坦福医疗中心以建立护理的新诊断MST患者。我们调查了从症状出现到首次预约初级保健医生的间隔时间（初级保健医生等待时间），以及从首次预约初级保健医生到获得首次影像学检查结果的间隔时间（影像学等待时间）和获得活检结果的间隔时间（活检等待时间）。肉瘤会诊等待时间定义为转诊日期与会诊日期之间的间隔。我们对肉瘤医生和非医生工作人员进行了关于等待时间认知的调查。在402名符合条件的患者中，约38.5%的患者初级保健医生等待时间超过5周，其中年轻人和西班牙裔患者此类长时间等待的比例最高。约20.6%的患者影像学等待时间超过5周，年轻人中此类长时间等待的比例最高。此外，与亚洲人相比，西班牙裔（P = 0.02）、黑人（P = 0.05）和白种人（P = 0.02）患者影像学等待时间超过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此类长时间等待的比例最高。此外，与公共保险相比，私人保险与初级保健医生等待时间、影像学等待时间、肉瘤会诊等待时间和活检等待时间超过5周的患者比例更高相关。调查结果绝大多数表明等待时间超过5周是不可接受的。在治疗开始前的护理过程多个环节中，存在与年龄组、种族和保险类型相关的MST护理方面的显著差异。我们的研究为缩小肉瘤护理差异的实践、研究和政策考量提供了见解。
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