Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country
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...
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my.um.eprints.191352018-09-06T01:37:22Z http://eprints.um.edu.my/19135/ Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country Kong, Y.C. Bhoo-Pathy, N. Subramaniam, S. Bhoo-Pathy, N. Mohd Taib, N.A. Jamaris, S. Kaur, K. See, M.H. Ho, G.F. Yip, C.H. R Medicine 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. MDPI 2017 Article PeerReviewed Kong, Y.C. and Bhoo-Pathy, N. and Subramaniam, S. and Bhoo-Pathy, N. and Mohd Taib, N.A. and Jamaris, S. and Kaur, K. and See, M.H. and Ho, G.F. and Yip, C.H. (2017) Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country. International Journal of Environmental Research and Public Health, 14 (4). p. 427. ISSN 1660-4601 http://dx.doi.org/10.3390/ijerph14040427 doi:10.3390/ijerph14040427 |
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R Medicine Kong, Y.C. Bhoo-Pathy, N. Subramaniam, S. Bhoo-Pathy, N. Mohd Taib, N.A. Jamaris, S. Kaur, K. See, M.H. Ho, G.F. Yip, C.H. Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country |
| description |
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. |
| format |
Article |
| author |
Kong, Y.C. Bhoo-Pathy, N. Subramaniam, S. Bhoo-Pathy, N. Mohd Taib, N.A. Jamaris, S. Kaur, K. See, M.H. Ho, G.F. Yip, C.H. |
| author_facet |
Kong, Y.C. Bhoo-Pathy, N. Subramaniam, S. Bhoo-Pathy, N. Mohd Taib, N.A. Jamaris, S. Kaur, K. See, M.H. Ho, G.F. Yip, C.H. |
| author_sort |
Kong, Y.C. |
| title |
Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country |
| title_short |
Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country |
| title_full |
Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country |
| title_fullStr |
Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country |
| title_full_unstemmed |
Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country |
| title_sort |
advanced stage at presentation remains a major factor contributing to breast cancer survival disparity between public and private hospitals in a middle-income country |
| publisher |
MDPI |
| publishDate |
2017 |
| url |
http://eprints.um.edu.my/19135/ http://dx.doi.org/10.3390/ijerph14040427 |
| _version_ |
1643690897783652352 |
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13.211869 |