Standardizing treatment for non-metastatic osteosarcoma may eliminate outcome disparities associated with poverty exposure and race/ethnicity, according to research presented at the 2022 ASCO Annual Meeting.

Researchers observed similar event-free survival (EFS) and overall survival (OS), regardless of race/ethnicity or poverty exposure, for young patients treated on the EURAMOS-1 trial. However, survival rates after relapse differed by race/ethnicity.

“[D]espite enrollment on trials, poverty, race, and ethnicity continue to be associated with worse outcomes in several pediatric malignancies, including leukemias, Hodgkin lymphoma, and neuroblastoma. The role of poverty, race, and ethnicity in osteosarcoma trial outcomes has not been investigated,” said study presenter Lenka Anne Skaidrite Ilcisin, MD, of Boston Children’s Hospital. 

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With this in mind, Dr Ilcisin and colleagues conducted a retrospective study of US patients with non-metastatic osteosarcoma who were enrolled in the EURAMOS-1 trial. The study included 758 patients who were 5 years to 21 years of age. 

Within the study cohort, 55% of patients were non-Hispanic White (NHW), 21% were Hispanic, 16% were non-Hispanic Black (NHB), and 5% were non-Hispanic other (NHO). Three percent of patients were missing data on race/ethnicity. 

In all, 26% of patients had household poverty exposure, and 28% had neighborhood poverty exposure. Household poverty was defined as coverage with public insurance (Medicaid or CHIP) only. Neighborhood poverty was defined as a high-poverty ZIP code according to the US Census, with more than 20% of residents living below the federal poverty level.

Neither poverty exposure (household or neighborhood) nor race/ethnicity were significantly associated with EFS (P =.9325) or OS (P =.1398). 

However, the post-relapse risk of death was significantly different across the race/ethnicity categories, with NHB patients having the greatest risk of post-relapse death. 

The 4-year relapse-free survival rate was 13% in NHB patients, 35.7% in Hispanic patients, 38.9% in NHW patients, and 43.8% in NHO patients (P=.0046).

“[T]his study, which demonstrates upfront survival equity but disparities in post-relapse care, offers the opportunity to recommit to equity for patients at all stages of treatment,” Dr Ilcisin said. “True equity must be measured not just in terms of survival or relapse, but the effects on patients’ families and the functional, social, and emotional well-being of our survivors.” 

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.  


Ilcisin LAS, Han R, Krailo MD, et al. 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. Presented at ASCO 2022; June 3-7, 2022. Abstract 10004.