title: Differences in primary care clinicians' approach to non-small cell lung cancer patients compared with breast cancer.
abstract: BACKGROUND
  Lung cancer is a disease with a stigma of being primarily self-induced. We hypothesize that this negative connotation for patients and physicians could lead to differences in referral patterns, treatment, and, ultimately, poorer outcomes compared with patients with non-self-induced diseases. We conducted a survey of primary care physicians to determine whether treatment and referral patterns of breast cancer patients differed from those of lung cancer patients.
  
  
  METHODS
  Case scenarios were mailed to 1132 primary care physicians in Wisconsin. Physicians were randomized to receive one of four scenarios on the basis of cancer type and smoking status. Physicians' referral patterns, length of follow-up, and knowledge about the benefits of chemotherapy were compared.
  
  
  RESULTS
  Six hundred seventy-two physicians replied (response rate 59.4%). On the basis of the responses to the clinical scenarios, physicians were less likely to refer patients with advanced lung cancer than patients with advanced breast cancer (p < 0.001). More physicians knew that chemotherapy improved survival in advanced breast cancer than in advanced lung cancer (p = 0.0145). Breast cancer patients were more likely to be referred for further therapy, whereas lung cancer patients were often referred only for symptom control (p = 0.0092). Yet, when asked directly, physicians stated that type of cancer was not a factor in their decisions to refer patients. There were no statistically significant differences between smoking and nonsmoking patients.
  
  
  CONCLUSIONS
  There is a difference in referral patterns and a lack of knowledge in the primary care community regarding the benefit of treatment of patients with lung cancer compared with breast cancer patients.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, Wisconsin, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Wassenaar
authors.forename: Jens C
authors.initials: JC
authors.lastname: Eickhoff
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Jarzemsky
authors.forename: Stevens S
authors.initials: SS
authors.lastname: Smith
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Larson
authors.forename: Joan H
authors.initials: JH
authors.lastname: Schiller
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000628:therapy*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*