Survival According to Source of Treatment Funding in Bladder Cancer: Analysis of a Large Public Database From São...

Previous studies have shown differences in patient profile and outcomes depending on the source of health care funding. Here, we evaluated the overall survival (OS) of patients with bladder cancer in public and in private systems in São Paulo, Brazil.

We conducted a retrospective cohort study of patients with bladder cancer registered in the Registro Hospitalar de Câncer da Fundação Oncocentro de São Paulo, a large state-wide database. Eligibility required a diagnosis of non-muscle-invasive or invasive bladder cancer between 2013 and 2018. The main objective was to compare OS between private and public treatment-funding sources.

Of 21,090 patients with bladder cancer since database inception, 6,217 were eligible (82.4% with a public source of health care funding). Patients with a public source had more advanced TNM stages at diagnosis and were less likely to have noninvasive papillary transitional-cell carcinoma. Within a 5-year follow-up period, median OS was not reached in either group. Funding source was significantly associated with OS in favor of private source (hazard ratio [HR], 1.72 [95% CI, 1.51 to 1.96]; P < .001), even after adjustment for age, TNM stage, and educational level (HR, 1.41 [95% CI, 1.21 to 1.65]; P < .001). The 5-year OS rate was 68.5% (95% CI, 68.5% to 68.5%) and 53.71% (95% CI, 53.7% to 53.7%) for private and public groups, respectively.

Public source of funding was associated with a lower OS for bladder cancer. Much progress is required to ensure higher standards of health care focusing on patients treated at public sources.