The association of diagnosis in the private or NHS sector on prostate cancer stage and treatment

Barbiere, J.M. Research Associate
Greenberg, D.C. Senior Analyst
Wright, K.A. Quality Assurance Officer
Brown, C.H. Medical Director
Palmer, C. Statistician
Neal, D.E. Professor of Surgical Oncology and Consultant Urological Surgeon
Lyratzopoulos, G. Clinical Senior Research Associate

¹Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, University Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
²Eastern Cancer Registration and Information Centre, Unit C—Magog Court, Shelford Bottom, Hinton Way, Cambridge CB22 3AD, UK
³Department of Uro-Oncology, Cancer Research UK Cambridge Research Institute, Addenbrooke's Hospital, Cambridge CB2 OQQ, UK

Address correspondence to G. Lyratzopoulos, E-mail: [email protected]

Journal of Public Health 34(1):p 108-114, March 2012. | DOI: 10.1093/pubmed/fdr051

Background

To examine associations of private healthcare with stage and management of prostate cancer.

Methods

Regional population-based cancer registry information on 15 916 prostate cancer patients.

Results

Compared with patients diagnosed in the National Health Service (NHS) (94%), those diagnosed in private hospitals (5%) were significantly more affluent (69 versus 52% in deprivation quintiles 1–2), younger (mean 69 versus 73 years) and diagnosed at earlier stage (72 versus 79% in Stages <III) (P < 0.001 for all). Private hospital of diagnosis was independently associated with lower probability of advanced disease stage [odds ratio (OR) 0.75, P = 0.002], higher probability of surgery use (OR 1.28, P = 0.037) and lower probability of radiotherapy use (OR 0.75, P = 0.001). Private hospital of diagnosis independently predicted higher surgery and lower radiotherapy use, particularly in more deprived patients aged ≤70.

Conclusions

In prostate cancer patients, private hospital diagnosis predicts earlier disease stage, higher use of surgery and lower use of radiotherapy, independently of case-mix differences between the two sectors. Substantial socioeconomic differences in stage and treatment patterns remain across centres in the NHS, even after adjusting for private sector diagnosis. Cancer registration data could be used to identify private care use on a population basis and the potential associated treatment disparities.