Hospital transfer after a breast cancer diagnosis

Heeg, E.; Schreuder, K.; Spronk, P. E.R.; Oosterwijk, J. C.; Marang-van de Mheen, P.J.; Siesling, Sabine; Peeters, Marie Jeanne Vrancken

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

Journal article (2019)

Authors

E. Heeg Leiden University Medical Center

K. Schreuder University of Twente, Integraal Kankercentrum Nederland (IKNL)

P. E.R. Spronk Leiden University Medical Center

J. C. Oosterwijk University Medical Center Groningen

P.J. Marang-van de Mheen Leiden University Medical Center

Sabine Siesling University of Twente, Integraal Kankercentrum Nederland (IKNL)

Marie Jeanne Vrancken Peeters Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis

Affiliation

External organisation

Breast cancer Discontinue of care Hospital transfer Treatment delay

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Published Date

2019

Language

English

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Abstract

Purpose: Patients may transfer of hospital for clinical reasons but this may delay time to treatment. The purpose of this study is to provide insight in the extent of hospital transfer in breast cancer care; which type of patients transfer and what is the impact on time to treatment. Methods: We included 41,413 breast cancer patients registered in the Netherlands Cancer Registry between 2014 and 2016. We investigated transfer of hospital between diagnosis and first treatment being surgery or neoadjuvant chemotherapy (NAC). Co-variate adjusted characteristics predictive for hospital transfer were determined. To adjust for possible treatment by indication bias we used propensity score matching (PSM). Time to treatment in patients with and without hospital transfer was compared. Results: Among 41,413 patients, 8.5% of all patients transferred to another hospital between diagnosis and first treatment; 4.9% before primary surgery and 24.8% before NAC. Especially young (aged <40 years) patients and those who underwent a mastectomy with immediate breast reconstruction (IBR) were more likely to transfer. The association of mastectomy with IBR with hospital transfer remained when using PSM. Hospital transfer after diagnosis significantly prolonged time to treatment; breast-conserving surgery by 5 days, mastectomy by 7 days, mastectomy with IBR by 9 days and NAC by 1 day. Conclusions: While almost 5% of Dutch patients treated with primary surgery transfer hospital after diagnosis and up to 25% for patients treated with NAC, our findings suggest that especially those treated with primary surgery are at risk for additional treatment delay by hospital transfer.