Disparities in Musculoskeletal Oncology

Abstract

Purpose of review: Disparities within the healthcare system serve as barriers to care that lead to poor outcomes for patients. These healthcare disparities are present in all facets of medicine and extend to musculoskeletal oncology care. There are various tenets to health disparities with some factors being modifiable and non-modifiable. The factors play a direct role in a patient's access to care, time of presentation, poor social determinants of health, outcomes and survival.

Recent findings: In musculoskeletal oncologic care, factors such as race, socioeconomic factors and insurance status are correlated to advanced disease upon presentation and poor survival for patients with a sarcoma diagnosis. These factors complicate the proper delivery of coordinated care that is required for optimizing patient outcomes. Healthcare disparities lead to suboptimal outcomes for patients who require musculoskeletal oncologic care in the short and long term. More research is required to identify ways to address the known modifiable and non-modifiable factors to improve patient outcome.

Keywords: Adverse health outcomes; Cancer; Disparities; Health disparities; Musculoskeletal oncology; Sarcoma; Socioeconomic status.

Fig. 1

An outline of specific modifiable and nonmodifiable health disparities that exist and contribute towards adverse health outcomes including increasing incidence, prevalence, morbidity, and mortality along with a higher burden of disease seen in certain populations [1]

Fig. 2

Self-identified sex and racial/ethnic breakdown of practicing orthopaedic surgeons in the United States from 2008 to 2018 [11]

Fig. 3

Annual rates of cancer deaths by race and ethnicity per 100,000 people shows that though rates have decreased over the past 20 years, differences still exist across races. Black individuals continue to be the race with the highest rates of cancer deaths [17]

Fig. 4

Area Deprivation Index (ADI) is a metric to describe the overall disparity within a zip code. High ADI indicates greater disparity and can be categorized 1–5. As ADI increases, screening completion rates of the area’s residents fall across all cancer types with routine screening [20]

Fig. 5

Cancer care is a tremendous financial burden. Acute Myeloid Leukemia is the most costly disease to treat, though all cancers depicted in this figure are costly and could be problematic for patients of lower socioeconomic status with poor financial stability and poor access to insurance [23]