Comparing survival outcomes for patients with colorectal cancer treated in public and private hospitals.

OBJECTIVE

To determine whether treatment in a private versus public hospital was an independent predictor of survival outcomes in patients with colorectal cancer.

DESIGN

Retrospective, population-based study.

SETTING

Tertiary care hospitals.

PARTICIPANTS

All patients diagnosed with colorectal cancer in Western Australia between 1993 and 2003.

INTERVENTIONS

Management in private versus public hospitals.

MAIN OUTCOME MEASURES

Overall survival and cancer-specific survival rates.

RESULTS

5809 patients were treated for colorectal cancer. Of these, 1523 (26%) were managed in private hospitals. The 5-year overall survival rates for private and public hospital patients were 59.4% (95% CI, 56.9%-61.9%) and 48.6% (95% CI, 47.0%-50.2%), respectively. Significant independent predictors of overall survival were: treatment in a private hospital (P = 0.0001; relative risk [RR], 0.764; 95% CI, 0.696-0.839); younger age (P = 0.0001; RR, 1.032; 95% CI, 1.029-1.036); male sex (P = 0.001; RR, 1.148; 95% CI, 1.068-1.234); and cancer stage (eg, Stage II: P = 0.0001; RR, 1.508; 95% CI, 1.316-1.729).

CONCLUSIONS

Treatment in a private hospital was a significant independent predictor of survival outcomes. Further validation of these results would have a significant bearing on how we approach health care delivery for patients with colorectal cancer.