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

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.

Surgical treatment of young women with breast cancer: Public vs private hospitals

“…31,32 Since stage at presentation can determine surgical management and overall survival, it is crucial to address factors that contribute to women presenting at advanced stages. 33 Interestingly, in our study, only 21 36 There is a hardship program that provides free genetic counseling to those without insurance at BH, yet the process to obtain testing may take several weeks, and results are not often available prior to surgery.…”

“…This was expected, as patients at the public hospital were more likely to be racial minorities, non‐English speakers, and have a lower education level, and studies have shown that women from lower SES backgrounds and younger women are more likely to present with aggressive breast cancer . Since stage at presentation can determine surgical management and overall survival, it is crucial to address factors that contribute to women presenting at advanced stages …”

The Current and Future Challenges of Hip Fracture Management in Malaysia

“…It is likely differences in patient characteristics and hip fracture treatment exist in these two sectors similar to what has been seen in the treatment of other healthcare conditions, e.g. cancer and antibiotic prescribing 41 , 42 .…”

Geographical Variation in Breast Cancer Outcomes

“…Reflecting the wide scope and complexities of the breast cancer pathway, the twelve studies included in this Special Issue covered a variety of measures including screening [ 7 ], incidence [ 8 ], stage at diagnosis [ 9 , 10 , 11 ], quality of life [ 12 ], diagnostic interval [ 13 ], hormonal profile [ 14 ], surgical treatment [ 15 ], survival [ 9 , 10 , 16 ], and mortality [ 17 , 18 ].…”

“…Pleasingly, the included studies reported geographical patterns across a wide range of international environments, including Europe [ 7 , 12 , 17 ], North America [ 8 , 11 , 16 ], Asia [ 9 , 14 , 18 ], and the Oceania region [ 10 , 13 , 15 ].…”