Disparities in Timeliness and Guideline-Concordant Treatment is Associated With Excess Mortality in Public Versus Private Lung Cancer Patients.

Abstract

Background: Previous literature has highlighted health inequality in lung cancer treatment, possibly related to differential healthcare delivery across public and private hospitals. In this study we assessed the association between public and private hospital receipt of guideline-concordant treatment (GCT) and survival.

Methods: A retrospective study of patients in the Victorian Lung Cancer Registry was performed between April 2011 and March 2022. Models were adjusted for propensity score (age, sex, performance status, histology, ethnicity, smoking, hospital location, socioeconomic status, comorbidities, comorbid cancer). Main outcome measures were timeliness of treatment, receipt of GCT, and survival between private and public hospital-admitted patients.

Findings: Of 11,396 patients, 9213 (81%) patients had treatment in public hospitals. Compared to private-hospital patients, public-hospital patients experienced substantial treatment delay (median referral-to-treatment interval: 48 vs. 29 days, p < 0.001). After adjusting for propensity score, private-hospital patients were more likely to receive GCT in all stages of non-small-cell lung cancer (NSCLC) except stage III (Stage I: OR 2.77, p < 0.001; Stage II: OR 3.43, p < 0.001; Stage III: 1.06, p = 0.73; Stage IV: OR 2.14, p < 0.001). The private-hospital patients had lower risk of death in NSCLC stages I, II and IV and a near-significant benefit in stage III (Stage I: OR 0.67, p < 0.001; Stage II: OR 0.54, p < 0.001; Stage III: 10.81, p = 0.06; Stage IV: OR 0.79, p < 0.001).

Interpretation: Compared to private, the public-hospital patients experienced substantial delay in lung-cancer treatment, lower standard of GCT, and poorer survival rate. This study highlights substantial health inequity and disparity, demanding a need to evaluate, assess, and improve lung cancer treatment in Australian hospitals.