The likelihood that patients with bone and soft-tissue sarcomas of the extremities and pelvis will have metastatic disease at the time of diagnosis is higher if the patient speaks Spanish as their preferred language, according to new research led by Wakenda Tyler, M.D., MPH, a musculoskeletal oncologist and division chief of orthopedic oncology at NewYork-Presbyterian and Columbia.
Bone and soft-tissue sarcomas are rare malignant tumors, with only about 3,000 cases of bone sarcoma and 12,000 cases of soft-tissue sarcoma diagnosed in the U.S. annually, according to estimates from the National Cancer Institute. The new study, which was published in the Journal of the American Academy of Orthopaedic Surgeons, is believed to be the first to explore a patient’s preferred language as a potential factor in delayed diagnosis for patients with bone and soft-tissue sarcoma.
Past studies, including some of my own research, have shown links between socioeconomic status and outcomes in sarcoma care but I wanted to see how the language itself influenced outcomes.
— Dr. Wakenda Tyler
Below, Dr. Tyler shares key findings from the study and explains how future research can test interventions aimed at reducing health disparities in bone and soft-tissue sarcomas.
Identifying Factors for Delayed Diagnosis
At NewYork-Presbyterian and Columbia, I see patients from a wide variety of backgrounds and for many of them, their primary language is not English. I noticed that these patients were presenting to me much later in the course of their disease than patients who had a very good grasp of English or whose primary language was English. Past studies, including some of my own research, have shown links between socioeconomic status and outcomes in sarcoma care but I wanted to see how the language itself influenced outcomes. We conducted a retrospective analysis of all the patients who had been seen at NewYork-Presbyterian and Columbia over the last 10 years who were diagnosed with bone or soft-tissue sarcoma of the extremity or pelvis, looking specifically at their preferred language and their metastatic stage at diagnosis.
We have enough information to show that these underserved communities are suffering and to inform the next steps to alleviate and prevent that suffering.
— Dr. Wakenda Tyler
Key Findings
Our study included 711 patients who were diagnosed with bone or soft-tissue sarcoma of the extremity or pelvis between 2004 and 2023. Overall, 17% of patients had a sarcoma that was at a metastatic stage at the time of diagnosis. Eleven percent of patients indicated Spanish as their preferred language. It’s not surprising but our data confirmed that if English was not your preferred language, you were more likely to present with a higher-grade tumor, which affects your likelihood of survival.
On univariate analysis, there was a strong correlation between preferred language and metastasis at diagnosis, with individuals whose primary language was Spanish being more than twice as likely to present with a metastatic sarcoma. The study also showed that insurance status was significantly associated with being diagnosed at a metastatic stage and in multivariate analysis, a lack of insurance was an independent risk factor for metastatic stage diagnosis.
Future Research
As we move forward, we should start by conducting a large-scale, national study so that we can look more granularly at some of the other social factors that could influence delays in diagnosis. But we should also be implementing and evaluating interventional approaches, such as educating primary care physicians on how to recognize sarcomas earlier and deploying community navigators who speak common languages such as Spanish, Mandarin, and Russian. For instance, we can begin to look at the outcomes when there are Spanish-speaking staff members in the clinic versus phone interpreters. NewYork-Presbyterian and Columbia are in a great position to be leaders in research in this area because of the communities that we serve, whether that’s in Washington Heights or Westchester. We don’t just see one type of patient and that lends itself to good opportunities for research and interventions.
A Call to Action
As we consider underserved communities that we know have poor outcomes on a whole spectrum of diseases in this country, I’m interested in doing something about that. We have enough information to show that these underserved communities are suffering and to inform the next steps to alleviate and prevent that suffering. On one end of the spectrum, we need to advocate on the national level for funding so that small hospitals can hire community navigators, and on the individual side, I urge clinicians not to wait to seek a consult or get an MRI. Many patients show up two or three months late and that’s just the right amount of time for those cancer cells to metastasize.
