Lung Cancer Patients Less Likely to See Specialists

Study found primary-care physicians more likely to send breast cancer patients to oncologists

SATURDAY, June 3, 2006 (HealthDay News) -- Primary-care physicians tend to send lung cancer patients to specialists less often than they do breast cancer patients, and those same doctors are less likely to think chemotherapy helps lung cancer patients live longer when compared to breast cancer patients.

However, whether or not the lung cancer patient smoked did not affect referral patterns, according to new research presented Friday at the American Society of Clinical Oncology (ASCO) annual meeting, in Atlanta.

"Lung cancer patients may be receiving less aggressive care compared to breast cancer patients," said study author Dr. Timothy R. Wassenaar, of the University of Wisconsin, Madison. "This is an excellent opportunity to educate primary-care physicians."

Lung cancer is the leading cancer killer in the United States, causing more deaths each year than breast, colon and prostate cancers combined. At the same time, people seem to view the disease differently.

"Historically, lung cancer has been stigmatized," explained Dr. Corey Langer, medical director of thoracic oncology at Fox Chase Cancer Center, in Philadelphia. "It's viewed as a self-inflected illness and, at least partially, it is."

"When you look at National Institutes of Health research dollars spent per diagnosis and per patient death, lung cancer is woefully below breast cancer and AIDS," he added.

To see if this stigma influenced the way primary-care physicians managed their patients, Wassenaar and his colleagues mailed surveys to 1,132 primary-care physicians and general internists in Wisconsin. Of that number, 672 physicians returned their surveys.

Half of the doctors received a survey describing a 53-year-old woman with a new diagnosis of breast cancer, while the other half received a survey regarding a 53-year-old woman with a new diagnosis of lung cancer. The surveys were further subdivided into patients who did and did not smoke.

Referrals were similar for patients with early stage disease, Wassenaar said. But fewer physicians referred patients with advanced disease to medical oncologists. In all cases, referrals were lower for lung cancer patients than for breast cancer patients.

"Primary-care physicians were less likely to refer lung cancer patients to medical oncologists," Wassenaar said. "The reasons are unclear, but there may be a subconscious bias or lack of knowledge of advances in treatment."

Survey respondents, on the other hand, said that type of cancer did not affect their decision.

Only 24 percent and 11 percent of physicians felt that chemotherapy would improve survival for early stage breast and lung cancer, respectively.

And only 41 percent and 31 percent of physicians believed chemotherapy would help the breast and lung cancer patients, respectively, live longer.

"We do a lousy job of publicizing our own advancements," Langer said. "Chemotherapy does perturb the natural history of lung cancer, but that message is not getting through to primary-care physicians."

The referral numbers for both types of cancer should be higher, he added.

"This is not a lung cancer misperception. It's also a breast cancer misperception," Langer emphasized. "It should be 100 percent. The knowledge deficit about adjuvant therapy is truly astounding."

More information

Visit the National Cancer Institute for more on lung cancer.

SOURCES: Corey Langer, M.D., medical director, thoracic oncology, Fox Chase Cancer Center, Philadelphia; June 2, 2006, news conference with Timothy R. Wassenaar, M.D., University of Wisconsin, Madison; presentation, June 2, 2006, American Society of Clinical Oncology, annual meeting, Atlanta
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