Cancer survival higher in "private" patients

Amnesiac_ie

From today's Irish Times Health Supplement

Survival rate best among private cancer patients
EITHNE DONNELLAN, Health Correspondent

A REVIEW of survival patterns among cancer patients treated across a range of hospitals in the State over a four-year period has found women with breast cancer who were treated in private hospitals had significantly higher survival rates.

They even had higher survival rates than women treated in the public hospitals which have now been designated as the State's eight cancer treatment centres.

The findings, published yesterday by the National Cancer Registry (NCR), relate however to survival patterns during the period 2000-2004, before the eight centres were identified.

Survival patterns among patients who attended private hospitals with colorectal and prostate cancer were also better.

Dr Harry Comber, one of the authors of Patterns of care and survival of cancer patients in Ireland 1994 to 2004 , said it was not known why some cancer patients fared better if their first surgical treatment was in a private hospital.

"We can speculate that patients in private hospitals tend to be better off, are less likely to be smokers, are less likely to have other illnesses other than their cancer which would interfere with their survival and also interfere with their fitness for surgery and chemotherapy and radiotherapy. That's probably the most likely reason," he said.

"In any country where people have looked at survival by socioeconomic class, survival is always better in the better off and it's not always possible to say exactly why that is but we presume it's because they just have less illness and because they have better nutritional status and so on," he added.

Asked if he was surprised survival rates for some cancers were better after treatment in private hospitals than even in some of the proposed designated centres, Dr Comber said many of the private hospitals were attached to the designated centres.

"So you are essentially dealing with the same doctors treating different groups of patients in what is to a large extent almost the same hospital. So that's the reason we think this is patient selection rather than anything to do with the sort of treatment they are getting."

The report states that the five-year relative survival of breast cancer patients whose first surgical treatment was in a private hospital was 90.1 per cent, compared with 87.3 per cent in the proposed specialist centres and 81.7 per cent in other public hospitals.

For prostate cancer, the five-year relative survival rate was 92.1 per cent among those treated at private hospitals, 81.8 per cent among those treated at the proposed specialist centres and 82.9 per cent at other public hospitals.

And among patients with colorectal cancer, the five-year survival rate after private hospital treatment was 73.7 per cent, compared with 60.9 per cent for those treated at the proposed specialist centres and 61.5 per cent among those treated at other public hospitals.

Meanwhile, the report notes overall that there have been "marked improvements in treatment and survival" of Irish cancer patients over the 1994-2004 period. But it says geographic disparities in treatment and survival are still evident. The west had the lowest level of radiation therapy for breast cancer for example.

Before Harney attempts to use this headline to suggest that the care in private hospitals is superior to that in the public system I think it is important to focus on the comments of Dr. Harry Comber.

"We can speculate that patients in private hospitals tend to be better off, are less likely to be smokers, are less likely to have other illnesses other than their cancer which would interfere with their survival and also interfere with their fitness for surgery and chemotherapy and radiotherapy. That's probably the most likely reason," he said.

"In any country where people have looked at survival by socioeconomic class, survival is always better in the better off and it's not always possible to say exactly why that is but we presume it's because they just have less illness and because they have better nutritional status and so on," he added.

I know many consultants who work in both the public and private sector and the vast majority will always try and look after the sickest/most serious cases in a public hospital with more subspecialty and NCHD back up. The real issue here of course is that cancer outcomes are better among the better off in Ireland and every other developed country.