Primary Care Doctors Less Likely to Refer Patients with Advanced Lung Cancer for Treatment

A new survey of primary care doctors in Wisconsin shows they are less likely to refer patients with advanced lung cancer to an oncologist than they are to refer patients with advanced breast cancer. This difference was seen despite the fact that most doctors surveyed said that the type and stage of a patient's cancer did not influence how strongly they encouraged patients to seek treatment.

Researchers surveyed 1,132 primary care doctors who were assigned one of four groups. Each group received a questionnaire asking how the doctor would care for the hypothetical patient. The only difference between the patients was whether they had lung cancer or breast cancer and whether they were smokers or nonsmokers.

Questionnaires were returned by 672 primary care doctors. Researchers found that 11% of doctors were likely to refer patients with advanced lung cancer to an oncologist, compared with 25% of doctors who said they would refer patients with advanced breast cancer to an oncologist. In addition, the primary care doctors were less likely to understand the benefits of chemotherapy for the treatment of advanced lung cancer—both as an adjuvant treatment after surgery and as a first-line treatment for recurrent cancer (cancer that has returned after treatment). Three quarters of the doctors surveyed did not know the benefits of chemotherapy for advanced lung cancer, and 65% did not know the benefits of chemotherapy for advanced breast cancer. Finally, only 30% of the primary care doctors knew that chemotherapy helped patients with recurrent lung cancer live longer, and 39% knew that chemotherapy helped patients with recurrent breast cancer live longer. The researchers found no statistical differences in how the doctors approached the treatment of smoking and nonsmoking patients for both types of cancer.

"Our findings suggest a bias in referral patterns on the part of primary care doctors," said Timothy R. Wassenaar, MD, the study's lead author and a hematology fellow at the University of Wisconsin School of Medicine and Public Health in Madison, where the research was conducted. "We also found a general lack of knowledge about the benefits of newer treatments for lung cancer that have come to the forefront over the past few years that have improved prospects for many patients."

What This Means For Patients

Cancer treatment information changes quickly. Patients with cancer are encouraged to discuss the risks and benefits of various treatment options with an oncologist in addition to their primary care doctor.