Poverty, race, ethnicity, and survival among U.S. children with non-metastatic osteosarcoma treated on EURAMOS-1: A report from the Children’s Oncology Group.

Abstract

10004 Background: Children living in poverty and those who identify as a race/ethnicity other than non-Hispanic White experience higher rates of relapse and lower overall survival across many pediatric cancers. Racial, ethnic and socioeconomic disparities have not been comprehensively investigated in osteosarcoma. We leveraged data from US-enrolled patients on the recent international EURAMOS-1 trial to investigate disparities in survival outcomes. Aim: Identify if race/ethnicity, household or neighborhood poverty exposure are associated with event-free survival (EFS) or overall survival (OS) in patients with non-metastatic osteosarcoma enrolled at a US-center on EURAMOS-1. Methods: Retrospective cohort study of US patients aged 5-21 years enrolled on EURAMOS-1 with a diagnosis of non-metastatic, primary osteosarcoma. Poverty was the primary exposure defined at the household- (sole coverage with Medicaid or CHIP public insurance versus other) and neighborhood- (Census-defined high-poverty ZIP code with >20% of residents living at <100% Federal Poverty Level vs other) levels. Race and ethnicity were categorized to reflect structural inequities and historically marginalized populations, as Hispanic, non-Hispanic Black (NHB), non-Hispanic Other (NHO), and non-Hispanic White (NHW). OS and EFS as a function of time from trial enrollment were estimated using the Kaplan-Meier method. Hypotheses of associations between risks for EFS-event, death and post-relapse death with poverty-exposures and race/ethnicity were assessed using log-rank tests. Statistical comparisons were performed excluding patients with missing values for the exposures considered. P-values <=0.05 were considered significant. Results: Among 758 patients, 27% were household poverty-exposed and 29% were neighborhood-poverty exposed. Twenty-one percent of children identified as Hispanic, 17% NHB, 5% NHO and 57% NHW. Neither household- or neighborhood-poverty, nor race/ethnicity were significantly associated with risks for EFS-event or death. Post-relapse risk for death differed significantly across race/ethnicity with NHB at greatest risk compared to others (4-Year post-relapse survival 35.7% Hispanic vs. 13.0% NHB vs. 43.8% NHO vs 38.9% NHW; p=0.0046). Conclusions: Neither poverty-exposures nor race/ethnicity were associated with EFS or OS in this COG trial-enrolled cohort, suggesting equitable outcomes following standardized therapy. Despite this, non-Hispanic Black children experienced significantly inferior post-relapse survival. Investigation of mechanisms driving these post-relapse disparities, including inequities in health care delivery and access to post-relapse trial-enrollment, are paramount to ensure equity in outcomes for all children with cancer.