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.