Hospital transfer after a breast cancer diagnosis: A population-based study in the Netherlands of the extent, predictive characteristics and its impact on time to treatment

Heeg, Erik; Schreuder, Kay; Spronk, P.E.R.; Oosterwijk, JC; Mheen, P.J. Marang-van de; Siesling, Sabine; Peeters, Marie‐Jeanne T. F. D. Vrancken

doi:10.1016/j.ejso.2018.12.017

Cited by 6 publications

(11 citation statements)

References 62 publications

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“…Patients who changed hospital after surgery were less likely to receive adjuvant chemotherapy within 6 weeks, but not within 9 or 12 weeks. Although this concerned only 3·2 per cent of all patients, the association corroborates the theory that hospital transfer delays treatment, as shown by previous studies.…”

Section: Discussionsupporting

confidence: 89%

Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

Heeg

Harmeling

Becherer

et al. 2019

British Journal of Surgery

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Background: Initiation of adjuvant chemotherapy within 6-12 weeks after mastectomy is recommended by guidelines. The aim of this population-based study was to investigate whether immediate breast reconstruction (IBR) after mastectomy reduces the likelihood of timely initiation of adjuvant chemotherapy.Methods: All patients with breast cancer who had undergone mastectomy and adjuvant chemotherapy between 2012 and 2016 in the Netherlands were identified. Time from surgery to adjuvant chemotherapy was categorized as within 6 weeks or after more than 6 weeks, within 9 weeks or after more than 9 weeks, and within 12 weeks or after more than 12 weeks. The impact of IBR on the initiation of adjuvant chemotherapy for these three scenarios was estimated using propensity score matching to adjust for treatment by indication bias.Results: A total of 6300 patients had undergone primary mastectomy and adjuvant chemotherapy, of whom 1700 (27⋅0 per cent) had received IBR. Multivariable analysis revealed that IBR reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (odds ratio (OR) 0⋅76, 95 per cent c.i. 0⋅66 to 0⋅87) and 9 weeks (0⋅69, 0⋅54 to 0⋅87), but not within 12 weeks (OR 0⋅75, 0⋅48 to 1⋅17). Following propensity score matching, IBR only reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (OR 0⋅95, 0⋅90 to 0⋅99), but not within 9 weeks (OR 0⋅97, 0⋅95 to 1⋅00) or 12 weeks (OR 1⋅00, 0⋅99 to 1⋅01).Conclusion: Postmastectomy IBR marginally reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks, but not within 9 or 12 weeks. Thus, IBR is not contraindicated in patients who need adjuvant chemotherapy after mastectomy.

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Section: Discussionsupporting

confidence: 89%

Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

Heeg

Harmeling

Becherer

et al. 2019

British Journal of Surgery

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“…These referral patterns are not easily identified by NCR’s registrars, especially when time since diagnosis passes, probably resulting in a somewhat smaller number of identified DBR patients. However, in a study on IBR a 5% hospital transfer was seen [ 46 ], which implies little incompleteness in our study. Active follow-up for all patients in the NCR is advisable.…”

Section: Discussionmentioning

confidence: 69%

Predictors of delayed breast reconstruction in the Netherlands: a 5-year follow-up study in stage I–III breast cancer patients

et al. 2021

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Purpose Delayed breast reconstruction (DBR) is a valid option for postmastectomy breast cancer patients who have a desire for breast reconstruction but are not considered suitable for immediate breast reconstruction (IBR). The objective of this study was to investigate the clinical practice and predictors of the use of DBR in the Netherlands. Methods Stage I–III breast cancer patients diagnosed from January to March 2012 and treated with mastectomy were selected from the Netherlands Cancer Registry. Routinely collected patient, tumor, treatment and hospital characteristics were complemented with data about DBR up to 2018. Multivariable logistic regression analyses were performed to identify factors independently associated with postmastectomy DBR. Factors associated with time to DBR were identified through Cox regression analyses. Results Of all patients who underwent mastectomy (n = 1,415), 10.2% underwent DBR. DBR patients more often received autologous reconstruction compared to IBR patients (37.5% vs 6.2%, p < 0.001). Age below 50 years (age < 35 OR 15.55, age 35–49 OR 4.18) and neoadjuvant and adjuvant chemotherapy (OR 2.59 and OR 2.83, respectively) were significantly associated with DBR. Mean time to DBR was 2.4 years [range 1–6 years]. Time to DBR was significantly associated with age < 35 years (HR 2.22), and a high hospital volume (HR 1.87). Discussion The use of DBR after mastectomy could not be fully explained by age below 50 years, chemotherapy, and hospital volume. Treatment with radiotherapy and adjuvant chemotherapy increased time to DBR. More information about patient preferences is needed to understand the use and timing of reconstruction.

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“…The SOs evaluated in the current study were provided in a tertiary hospital with high expertise on breast cancer care 6. Previous studies have suggested that expertise in treatments such as the use of NST and IBR might be indications for an SO or a change of hospital after diagnosis 9,29. This is partly true, as results from a national audit show that the use of NST and IBR in the NCI-AVL is above the national Dutch average 6.…”

Section: Discussionmentioning

confidence: 98%

Impact of Second Opinions in Breast Cancer Diagnostics and Treatment: A Retrospective Analysis

et al. 2019

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BackgroundBreast cancer care is becoming increasingly complex, and patients with breast cancer are increasingly aware of the different treatment options, resulting in requests for second opinions (SOs). The current study investigates the impact of breast cancer SOs on final diagnosis and treatment in the Netherlands Cancer Institute (NCI) using a newly designed Breast Cancer Second Opinion (BCSO) classification system.MethodsPatients who visited the NCI for an SO between October 2015 and September 2016 were included. Demographics, diagnostics, and treatment proposals were compared between first and SO. Discrepancy was categorized using our BCSO classification system, categorizing SOs into (1) noncomparable, (2) identical, and (3) minor or (4) major discrepancy.ResultsThe majority of SOs (n = 591) were patient initiated (90.7%). A total of 121 patients underwent treatment prior to their SO, leaving 470 patients for assessment of discrepancies according to our BCSO classification system. More than 45% of these SOs resulted in at least one discrepancy, with comparable rates for physician- and patient-initiated SOs (42.5% vs. 45.6%, p = 0.708). Significantly more discrepancies were observed in patients with additional imaging (51.3% vs. 37.2%, p = 0.002) and biopsies (53.7% vs. 40.3%, p = 0.005). Almost 60% of all discrepancies were categorized as major (neoadjuvant systemic treatment instead of primary surgery, breast-conserving surgery instead of mastectomy, and proposing postmastectomy immediate breast reconstruction).ConclusionsOur findings show substantial differences in diagnostic and treatment options in breast cancer patients visiting the Netherlands Cancer Institute for an SO, thereby emphasizing more consensus for the indications of these treatment modalities.

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Hospital transfer after a breast cancer diagnosis: A population-based study in the Netherlands of the extent, predictive characteristics and its impact on time to treatment

Cited by 6 publications

References 62 publications

Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

Predictors of delayed breast reconstruction in the Netherlands: a 5-year follow-up study in stage I–III breast cancer patients

Impact of Second Opinions in Breast Cancer Diagnostics and Treatment: A Retrospective Analysis

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