ASCO: Primary Care Physicians Slow to Urge Aggressive Lung Cancer Treatment

June 3, 2006

ATLANTA ? Many patients with early-stage non-small-cell lung cancer (NSCLC) never see a medical oncologist because their primary care physicians don't think chemotherapy can help them, according to survey results reported here.

ATLANTA, June 3 ? Many patients with early-stage non-small-cell lung cancer (NSCLC) never see a medical oncologist because their primary care physicians don't think chemotherapy can help them, according to a survey reported here.

But in the eyes of primary care physicians, early breast cancer is a different story, said Timothy R. Wassenaar, M.D., of the University of Wisconsin School of Medicine and Public Health in Madison, a hematology fellow.

Primary care physicians, Dr. Wassenaar and colleagues reported at the American Society of Clinical Oncology meeting here , are aware that adjuvant chemotherapy improves survival in women with breast cancer, and they are more willing to refer them to medical oncologists.

Dr. Wassenaar and colleagues surveyed 1,132 Wisconsin primary care physicians from April 1, 2005, through Oct. 31, 2005. Half were asked questions are about a clinical scenario involving a 53-year-old woman newly diagnosed with stage 1b breast cancer and half were asked about a 53-year-old woman with a new diagnosis of stage 1b NSCLC cancer. The surveys were further subdivided into patients who used or did not use tobacco.

The physicians were asked to about likely referral as the patient progressed from early-stage to late-stage disease. They were also asked their opinion about the value of chemotherapy at various stages of disease.

Six hundred and seventy-two physicians (59.4%) responded to the surveys.

Twenty-four percent of the primary care physicians said they believed women with early-stage breast cancer would benefit from chemotherapy, versus 11% who thought chemotherapy would benefit patients with early-stage lung cancer (P

Thoracic surgeon Yolanda L. Colson, M.D., of Brigham and Women's Hospital in Boston said the survey results reflect her own clinical experience. "There is a tremendous bias out there," she said. "It's not just primary care physicians, it is the patients and the families."

"I frequently have patients who have to be convinced that they should pursue treatment for lung cancer," she said. "The typical response is 'lung cancer? I deserve it because I smoked.'" Dr. Colson chaired an ASCO press briefing where Dr. Wassenaar reported his findings.