AUTHOR=Andrade Diocésio Alves Pinto , Veneziani Ana Carolina , Paiva Carlos Eduardo , Reis Ricardo dos , Filho Carlos Alberto Fruet , Sanches André Octávio Nicolau , Barroso Alison Wagner Azevedo , Paz Alessandra Caroline Moretto Carbinatto , Kons Georgia Cristina de Mello , Preto Daniel D’Almeida , Budib Maria Carolina Bogoni , Safro Maria Augusta , Pinto Gustavo Sanches Faria , Bilibio João Paolo , Souza Cristiano de Pádua TITLE=Discrepancies in breast cancer’s oncological outcomes between public and private institutions in the southeast region of Brazil: a retrospective cohort study JOURNAL=Frontiers in Oncology VOLUME=13 YEAR=2023 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1169982 DOI=10.3389/fonc.2023.1169982 ISSN=2234-943X ABSTRACT=Background

Brazil is a middle-income country with inequalities in its healthcare system. The disparities between public and private services affect the diagnosis and treatment of patients with breast cancer. The aim of this study is to assess whether disease-free survival (DFS) and overall survival (OS) are different in public and private specialized centers.

Patient and methods

A retrospective cohort study with 1,545 breast cancer patients diagnosed from 2003 to 2011 at Barretos Cancer Hospital—BCH (public group, N = 1,408) and InORP Oncoclinicas (private group, N = 137) was conducted. A 1:1 propensity score matching (PSM) analysis was used to adjust the differences between the groups’ characteristics (n = 137 in each group).

Results

The median age at diagnosis was 54.4 years. Estimated DFS rates at 1, 5, and 10 years were 96.0%, 71.8%, and 59.6%, respectively, at BCH and 97.8%, 86.9%, and 78%, respectively, at InORP (HR: 2.09; 95% confidence interval [CI], 1.41–3.10; p < 0.0001). Estimated OS rates at 1, 5, and 10 years were 98.1%, 78.5%, and 65.4%, respectively, at BCH and 99.3%, 94.5%, and 91.9%, respectively, at InORP (HR: 3.84; 95% CI, 2.16–6.82; p < 0.0001). After adjustment by PSM, DFS and OS results in 1, 3, and 5 years remained worse in the public service compared to the private service.

Conclusion

Patients treated in a public center have worse DFS and OS after a follow-up period of more than 5 years. These results were corroborated after carrying out the PSM.