Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country

Yek-Ching Kong, Nirmala Bhoo-Pathy, Shridevi Subramaniam, Nanthini Bhoo-Pathy, Nur Aishah Taib, Suniza Jamaris, Kiran Kaur, Mee-Hoong See, Gwo-Fuang Ho and Cheng-Har Yip
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Yek-Ching Kong: National Clinical Research Centre, Ministry of Health, Kuala Lumpur 50586, Malaysia
Nirmala Bhoo-Pathy: Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Shridevi Subramaniam: National Clinical Research Centre, Ministry of Health, Kuala Lumpur 50586, Malaysia
Nanthini Bhoo-Pathy: Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Nur Aishah Taib: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
Suniza Jamaris: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
Kiran Kaur: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
Mee-Hoong See: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
Gwo-Fuang Ho: Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur 59100, Malaysia
Cheng-Har Yip: Subang Jaya Medical Centre, Subang Jaya, Selangor 47500, Malaysia

IJERPH, 2017, vol. 14, issue 4, 1-10

Abstract: Background: Survival disparities in cancer are known to occur between public and private hospitals. We compared breast cancer presentation, treatment and survival between a public academic hospital and a private hospital in a middle-income country. Methods: The demographics, clinical characteristics, treatment and overall survival (OS) of 2767 patients with invasive breast carcinoma diagnosed between 2001 and 2011 in the public hospital were compared with 1199 patients from the private hospital. Results: Compared to patients in the private hospital, patients from the public hospital were older at presentation, and had more advanced cancer stages. They were also more likely to receive mastectomy and chemotherapy but less radiotherapy. The five-year OS in public patients was significantly lower than in private patients (71.6% vs. 86.8%). This difference was largely attributed to discrepancies in stage at diagnosis and, although to a much smaller extent, to demographic differences and treatment disparities. Even following adjustment for these factors, patients in the public hospital remained at increased risk of mortality compared to their counterparts in the private hospital (Hazard Ratio: 1.59; 95% Confidence Interval: 1.36–1.85). Conclusion: Late stage at diagnosis appears to be a major contributing factor explaining the breast cancer survival disparity between public and private patients in this middle-income setting.

Keywords: breast cancer; overall survival; public vs. private hospital (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2017
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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