The Relationship Between Area-Level Marginalization and Overall Survival of Patients with Soft Tissue Sarcoma in Ontario: A Retrospective Cohort Study

BackgroundSocioeconomic status and community marginalization can impact overall survival and functional outcome in patients with cancer. However, this association has not been determined in patients with soft tissue sarcoma (STS) within Canada. The primary aim of this study was to determine the impact of marginalization on STS 5-year overall survival.Patients and MethodsWe conducted a retrospective cohort study of patients presenting with primary or locally recurrent STS who underwent surgical resection between January 2010 and December 2021. Marginalization was determined using the Ontario Marginalization Index (ON-Marg), with subdomains including Ethnic Concentration, Material Resources, Household Dwelling, and Labor Dependency, and patients were stratified into quintiles (Q1 = least marginalized; Q5 = most marginalized). The association between marginalization and overall survival was determined using Kaplan-Meier curves and a multivariate Cox proportional hazards model.ResultsWhen adjusted for age and grade of disease, 5-year overall survival was not impacted by Ethnic Concentration (75.2% Q1 vs. 80.5% Q5). However, 5-year overall survival was significantly affected by increasing marginalization within Material Resources (81.9% Q1 vs. 69% Q5), Household Dwelling (82.2% Q1 vs. 69.6% Q5), and Labor Dependency (75.4% Q1 vs. 67.3% Q5). Significant differences across quintiles with regard to 1-year functional outcomes were noted with the Toronto Extremity Salvage Score, while nonsignificant changes were noted with the Musculoskeletal Tumor Society Score-93.ConclusionsThis study is the first to demonstrate marginalization as an independent risk factor adversely impacting 5-year overall survival of STS in Canada's single-payer universal healthcare system.