title: Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma.
abstract: BACKGROUND
  Elderly patients (EPs) suffering from retroperitoneal rhabdomyosarcoma (RRMS) carry a considerably poorer prognosis compared to younger patients (YPs). We hypothesized that EPs received less aggressive and comprehensive treatment than YPs, resulting in poorer survival outcomes.
  
  
  METHODS
  All patients diagnosed with RRMS since 1998 in the National Cancer Data Base (NCDB) were reviewed for patient demographics, tumor characteristics, treatment modalities and survival outcomes.
  
  
  RESULTS
  Of the 100 patients identified, 35 % were ≥65 years of age. EPs (aged ≥65 years), when compared to YPs (aged <65), were less likely to receive systemic chemotherapy (20 % EPs vs 71 % YPs, p < 0.001) and treatment at an academic center (34 % EPs vs 60 % YPs, p = 0.05), although the frequency of radiation (23 % EPs vs 31 % YPs, p = 0.40) and radical surgery (26 % EPs vs 22 % YPs, p = 0.55) were similar. EPs received treatment more frequently at comprehensive community cancer programs (57 %) and had a shorter median distance of travel for care (6.4 vs 13 miles, p = 0.009). After adjusting for gender and tumor size, EPs had a hazard ratio of 3.6 (95 % CI 1.8-7.2, p < 0.001), with a median survival of 2 months (interquartile range [IQR] 1-8 months) versus 17 months for YPs (IQR 8-43 months).
  
  
  CONCLUSIONS
  Altered practice patterns exist for EPs and include reduced use of systemic chemotherapy which may contribute to poorer outcomes for RRMS patients. Although regionalization of care poses challenges, this may offer benefit to the EP group.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kashtan
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
authors.forename: Thejus T
authors.initials: TT
authors.lastname: Jayakrishnan
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Rajeev
authors.affiliation: Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Charlson
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
authors.forename: Fabian
authors.initials: F
authors.lastname: Johnston
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
authors.forename: T
authors.initials: T
authors.lastname: Clark Gamblin
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA. kturaga@mcw.edu.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000706:statistics & numerical data; D012186:Retroperitoneal Neoplasms / Q000628:therapy*; D012208:Rhabdomyosarcoma / Q000628:therapy*; D015996:Survival Rate; D014481:United States
chemical_list: D000970:Antineoplastic Agents
keywords: Disparities; Elderly; Retroperitoneal; Rhabdomyosarcoma; Sarcoma