Impact of sociodemographic and clinical factors on time to treatment initiation in adult soft tissue sarcomas: An NCDB analysis.
Authors: Kian Steppe, Humza Razaq, Bibi Maryam, Evan Becker, Sara Vesely, Ryan David Nipp, Minh Duc Phan
Journal: Journal of Clinical Oncology (2025)

e23548 Background: Soft tissue sarcomas (STS) are a heterogeneous group of cancers that often require complex, multidisciplinary care. Delays in initiating STS treatment generally correspond with worse outcomes, yet factors associated with time to treatment initiation (TTI) in STS remain poorly understood. We aim to identify key factors associated with variations in TTI among adult patients with STS. Methods: We analyzed data from the National Cancer Database (NCDB) to assess TTI in U.S. adults (18+) with a diagnosed with histologically confirmed STS from 2004-2021. TTI was defined as the time from diagnosis to first definitive treatment, excluding TTI values of 0 or greater than 120 days. We performed descriptive analysis of sociodemographic (i.e., race, ethnicity) and clinical (i.e., grade, stage) factors, and evaluated associations with TTI using a nonparametric Kruskal-Wallis test. Results: We identified 103,682 patients with STS (median age: 61 years, male: 55.1%, female: 44.9%, White: 76.8%, Black: 10.5%, Hispanic: 7.4%, Asian: 3.3%, American Indian: 0.3%, Other: 1.0%). The median (m) TTI was 35 days, increasing by 32.3% over the study period, from 31 to 41 days. Significant differences (p &lt; 0.0001) were observed across sociodemographic and clinical variables. The highest and lowest median TTI (m days) values from each group are summarized below. Younger patients (18-29 years) had the shortest median TTI (m = 32), while older patients (70+ years) had the longest (m = 36). For race/ethnicity, Hispanic patients had the longest (m = 38), while White, non-Hispanic patients had the shortest TTI (m = 35). Higher education and income quartiles were linked to shorter TTIs (m = 34), with patients in the lowest income and education quartiles having the longest (m = 36). Uninsured patients and those with Medicaid or Medicare had the longest TTI (m = 36), compared to those with private insurance (m = 34). Patients treated at academic programs had the longest TTI (m = 36), while those treated at community cancer programs had the shortest (m = 35). Regarding primary site, head/neck tumors had the longest TTI (m = 40), while heart/unsure/NOS tumors had the shortest (m = 33). Treatment centers located in the Pacific region had the longest median TTI (m = 38), with the lowest in the West North Central region (m = 33). Larger tumors (&gt; 10cm) (m = 33) associated with shorter TTIs, contrasting tumors below 5cm (m = 39). Poorly differentiated tumors had the shortest TTI (m = 34), while low-grade tumors had the longest (m = 39). Conclusions: In this large cohort of adults with STS, the median TTI was over one month. We identified several factors significantly associated with variations in TTI within this sample. Enhancing our understanding of these factors may help to develop targeted interventions and further research aimed at reducing treatment delays and examining how TTI correlates with STS survival outcomes.