Poverty, race, ethnicity, and survival in pediatric nonmetastatic osteosarcoma: a Children’s Oncology Group report

Ilcisin L, Han R, Krailo M, Shulman DS, Weil BR, Weldon CB, Umaretiya P, Aziz-Bose R, Greenzang KA, Gorlick R, Reed DR, Randall RL, Nadel H, Binitie O, Dubois SG, Janeway KA, Bona K. Poverty, race, ethnicity, and survival in pediatric nonmetastatic osteosarcoma: a Children’s Oncology Group report. J Natl Cancer Inst. 2024 Oct 1;116(10):1664-1674. doi: 10.1093/jnci/djae103. PMID: 38926133.

Children living in poverty and those of marginalized race or ethnicity experience inferior disease outcomes across many cancers. Whether survival disparities exist in osteosarcoma is poorly defined. We investigated the association between race, ethnicity, and proxied poverty exposures and event-free and overall survival for children with nonmetastatic osteosarcoma receiving care on a cooperative group trial. We conducted a retrospective cohort study of US patients with nonmetastatic, osteosarcoma aged 5-21 years enrolled on the Children’s Oncology Group trial AOST0331. Race and ethnicity were categorized to reflect historically marginalized populations, as Hispanic, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White. Poverty was proxied at the household and neighborhood levels. Overall survival and event-free survival functions of time from trial enrollment were estimated using the Kaplan–Meier method. Hypotheses of associations between risks for event-free survival, death, and postrelapse death with race and ethnicity were assessed using log-rank tests.