Impact of socioeconomic status and travel distance on treatment outcomes in soft tissue sarcoma: A retrospective analysis from a high volume tertiary care center

Introduction: Soft tissue sarcomas (STS) are rare mesenchymal tumors with substantial clinical complexity. Although tumor size, grade, and histology are established prognostic factors, socioeconomic status (SES) and geographic access to specialized care may also influence outcomes. Prior studies in multiple cancers show that socioeconomic disadvantage and longer travel distances can delay treatment and worsen prognosis. High-volume sarcoma centers offer multidisciplinary management that improves survival, yet SES-related barriers may still affect access. This study evaluates the impact of SES, travel distance, treatment patterns, and survival outcomes among STS patients treated at a high-volume tertiary center. Methods: A retrospective cohort of 364 patients with primary STS treated over 20 years at a single tertiary center was analyzed. Patients with metastatic disease at diagnosis, incomplete treatment data, or inadequate follow-up were excluded, leaving 357 eligible patients. SES was measured using the Area Deprivation Index (ADI) and classified as high (ADI 8-10) or low (0-7) deprivation. Travel distance was calculated using the Haversine formula. Kaplan-Meier analyses assessed overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). Logistic regression evaluated factors associated with wound complications. Results: No significant differences were found in OS (p=0.2), PFS (p=0.3), DMFS, or wound complications (p=0.1) between high- and low-ADI groups. Treatment patterns were similar, including adjuvant chemotherapy (8.9% vs. 8.7%, p=1.000) and radiation (10.7% vs. 11.8%, p=1.000). High-ADI patients traveled slightly farther (median 24.8 vs. 18.5 miles), but this modest increase was not associated with differences in treatment delivery or outcomes. On multivariate analysis, tumor grade, age, and Karnofsky Performance Status predicted OS. Conclusion: Despite marginally longer travel distances, socioeconomically disadvantaged patients had comparable treatment patterns and survival outcomes to more advantaged patients. The small travel difference did not impede access to multidisciplinary sarcoma care. High-volume tertiary centers may help mitigate SES-related disparities by providing equitable, standardized treatment across diverse populations.