# The Role of Race and Ethnicity on Time to Treatment in Orthopaedic Oncology

## TL;DR

This study finds racial and ethnic disparities in treatment delays for bone and soft tissue cancers, with Hispanic and Black patients experiencing both shorter and longer delays depending on the treatment type and disease stage.

## Contribution

The study identifies race- and ethnicity-based differences in time to treatment for orthopaedic oncology patients, revealing disparities in non-emergent care pathways.

## Key findings

- Hispanic and Black patients had shorter times to surgery in metastatic bone disease but longer delays in non-emergent treatments like radiation.
- Disparities in time to treatment varied by treatment modality and clinical context, suggesting inequities in access to coordinated care.
- Reporting both mean and median times revealed a more nuanced understanding of treatment delays across racial and ethnic groups.

## Abstract

Delays in cancer treatment can lead to worse outcomes, yet limited data exists on how these delays affect patients with bone and soft tissue malignancies. Orthopaedic oncologists specialize in managing both benign and malignant bone and soft tissue tumors, including sarcomas, which are rare mesenchymal cancers requiring surgery, often alongside chemotherapy and/or radiation. Orthopaedic oncologists also surgically manage metastatic cancer to bone when fractures are impending or have occurred. Unfortunately, delays in diagnosis and treatment are common. Using a large national database, this study examined whether time to treatment differs by race and ethnicity in patients with bone sarcomas, soft tissue sarcomas, and metastatic cancer to bone. We found that Hispanic and Black patients often underwent surgery sooner in the metastatic setting, likely reflecting presentation with more advanced disease, such as displaced pathologic fracture. However, both groups experienced longer delays in non-emergent treatments, including resection and radiation when compared to white patients. These findings highlight the importance of improving early access to orthopaedic oncologists and developing care pathways that ensure all patients receive timely, coordinated cancer treatments.

Background: Timely treatment is critical for patients with bone and soft tissue tumors, but access to care may not be equitable across all populations. While treatment delays have been well studied in other cancers, disparities in time to treatment remain underexplored in orthopaedic oncology. This study aimed to determine whether racial or ethnic disparities exist in the timing of surgery, chemotherapy, or radiation for patients with sarcoma or metastatic bone disease. Methods: A retrospective cohort study was conducted using the TriNetX US Collaborative Network, a multi-institutional electronic health record database. Adult patients undergoing biopsy and subsequently diagnosed with bone sarcoma, soft tissue sarcoma, or metastatic bone disease were identified. Time to treatment was defined as the number of days between biopsy and the first recorded surgery, chemotherapy, or radiation. Patients were stratified by race and ethnicity, and statistical comparisons were performed using Mann–Whitney U tests and t-tests. Results: A total of 63,087 patients met inclusion criteria (55,697 with metastatic bone disease/bone sarcoma and 7390 with soft tissue sarcoma). In the metastatic/bone sarcoma cohort, Hispanic patients had shorter mean time to resection (58 ± 94 vs. 82 ± 239 days, p = 0.008) and fixation (35 ± 142 vs. 72 ± 315 days, p < 0.001) compared to non-Hispanic patients, although median times did not differ significantly. Among black patients, time to fixation was shorter than in White patients (mean 22 ± 103 vs. 114 ± 468 days, p < 0.001; median 0 days in both groups), while delays were observed in time to radiation (median 13 vs. 7 days; mean 85 ± 284 vs. 43 ± 203 days, p < 0.001). In the soft tissue sarcoma cohort, Black patients experienced longer mean times to resection (142 ± 293 vs. 79 ± 216 days) and radiation (141 ± 514 vs. 96 ± 364 days), though comparisons were limited by sample size. Conclusions: This large, multi-institutional study demonstrates that disparities in orthopaedic oncology differ by treatment modality and clinical context. Shorter wait times to surgery among Hispanic and Black patients in metastatic disease likely reflect more advanced disease presentation and barriers to early access, whereas delays in resection and radiation highlight inequities in accessing non-emergent, coordinated oncologic care. Reporting both means and medians provides a more complex understanding of treatment delays and underscores the need for interventions that expand early access to orthopaedic oncologists and ensure timely, equitable care.