Colorectal cancer survival outcomes better for private hospital patients

Patients with metastatic colorectal cancer (mCRC) receive more treatment and have significantly better survival times if treated in a private hospital rather than the public system, a study from South Australia shows.

A review of data for 3470 patients treated for mCRC between 2006 – 2015 found that 30% were treated in private hospitals.

Public patients had higher burden of disease with ≥ 3 metastatic sites involved (10.5% vs 7.4%, p=0.005), and were less likely to have oligometastatic (only one metastatic site) disease than patients treated in private hospitals, according to the findings published by researchers from Flinders Medical Centre and Flinders University.

Public patients received 50% less treatment compared to the private patients (OR = 0.5, p=0.01) and had significantly lower rates of colorectal surgery (OR 0.82, p = 0.028). They received significantly less systemic therapy (OR = 0.5) than private patients, received less chemotherapy alone (OR = 0.69) and less chemotherapy + targeted therapy (OR = 0.67).

After adjusting for the covariates such as functional status, public hospital patients survived 1.41 months (p = 0.034) less than private patients during a follow up time of five years.

Colorectal cancer outcomes differences were particularly marked for patients that had metastasectomy, who experienced an average survival increase of over 20 months (20.04(19.33, 22.75), p < 0.001), compared to those that did not have metastasectomy.

Patients in private hospitals were more likely than those in public hospitals to have more than three lines of therapy. Patient who had more than three lines of therapy experienced an average survival increase of over 13 months compared to those that received three or less lines of therapy.

As expected, patients from higher income groups were more likely to be treated in the private system than a public hospital (41.2% vs 21.6%)

Writing in the Internal Medicine Journal, the study authors said their findings confirmed those of previous Australian studies showing better outcomes for patients with colorectal cancer treated in private hospitals. And it was notable that the main factor associated with improved survival was increased delivery of surgical and systemic treatment, they said.

“Median survival in clinical trials utilising the newest regimes [is] now reaching 30 months in some subgroups, in contrast to untreated patients who have a median survival of approximately 5- 6 months or even lower in the real world setting,” they noted.

Since both public and private patients should have equal access to treatment in a universal health system the differences in outcomes between public and private patients may be related to factors such as delay to presentation in early stage settings, or levels of co-morbidity, they suggested.

Other factors could include poor compliance with recommended treatments, and longer waiting times for treatment in the public system compared to private hospitals.

“In an era where progress in terms of cancer detection and treatment has been rapid, we have not witnessed an improvement in outcome disparities between these two groups. In fact, while our understanding of cancer biology, screening techniques and treatment has improved significantly over the last 20 years, socio-economic status disparities in cancer mortality remain,” they concluded.

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