title: Comparing the case mix and survival of women receiving breast cancer care from one private provider with other London women with breast cancer: pilot data exchange and analyses.
abstract: Data from providers of private cancer care are not yet formally included in English cancer registration data. This study aimed to test the exchange of breast cancer data from one Hospital Corporation of America International (HCAI) hospital in London with the cancer registration system and assess the suitability of these data for comparative analyses of case mix and adjusted survival.
  
  
  
  Data on 199 London women receiving 'only HCAI care', 278 women receiving 'some HCAI care' (HCAI and other services), and 31,234 other London women diagnosed between 2005 and 2011 could be identified and compared. Overall survival was estimated using the Kaplan-Meier method, and Cox regression was used to adjust for age, socioeconomic deprivation, year of diagnosis, stage of disease and recorded treatment.
  
  
  
  Women receiving 'only HCAI care' were younger, lived in areas of higher affluence (47.8 % vs 27.6 %) and appeared less likely to be recorded as having screen-detected (2.5 % vs 25.0 %) disease than other London women. Women receiving 'some HCAI care' were more similar to 'HCAI only' women. Although HCAI stage of disease data completeness improved during the study period, this was less complete overall than cancer registration data and limited the comparative survival analyses. An apparent survival advantage for 'HCAI only' women compared with other London women (hazard ratio 0.48, 95 % confidence interval (CI): 0.32-0.74) was attenuated and no longer statistically significant after adjustment (0.79, 95 % CI: 0.51-1.21). Women receiving 'some HCAI care' appeared to have higher survival (hazard ratio 0.24, 95 % CI 0.14-0.41) which was attenuated to 0.48 (95 % CI: 0.28-0.80) in the fully adjusted model.
  
  
  
  Exchange of data between the private cancer sector and the English cancer registration service can identify patients who receive all or some private care. The better survival of women receiving only or some HCAI breast cancer care appears to be at least partly explained by demographic, disease, and treatment factors. However, larger studies using similarly quality assured datasets and more complete staging data from the private sector are needed to produce definitive comparative results.
authors.affiliation: Public Health England, Knowledge and Intelligence (London), 2nd Floor, Skipton House, 80 London Road, London, SE1 6HL, UK. Elizabeth.Davies@kcl.ac.uk.|King's College London, Health and Social Care Research, Faculty of Health Sciences & Medicine, 5th Floor, Capital House, 42 Weston Street, London, SE1 3QD, UK. Elizabeth.Davies@kcl.ac.uk.|Health and Social Care Research, Faculty of Health Sciences & Medicine, 5th Floor, Addison House, London, SE1 IUL, UK. Elizabeth.Davies@kcl.ac.uk.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Davies
authors.affiliation: Public Health England, Knowledge and Intelligence (London), 2nd Floor, Skipton House, 80 London Road, London, SE1 6HL, UK.
authors.forename: Victoria H
authors.initials: VH
authors.lastname: Coupland
authors.affiliation: HCA International Ltd, 242 Marylebone Road, London, NW1 6JL, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Dixon
authors.affiliation: HCA International Ltd, 242 Marylebone Road, London, NW1 6JL, UK.
authors.forename: Kefah
authors.initials: K
authors.lastname: Mokbel
authors.affiliation: Public Health England, Knowledge and Intelligence (London), 2nd Floor, Skipton House, 80 London Road, London, SE1 6HL, UK.
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Jack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality*; D003953:Diagnosis-Related Groups; D005260:Female; D016304:Hospitals, Private; D006801:Humans; D008131:London; D008875:Middle Aged; D010865:Pilot Projects; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D016019:Survival Analysis
keywords: Breast cancer; Health care organisation; Inequalities; Survival