E Heeg1, K Schreuder2, P E R Spronk3, J C Oosterwijk4, P J Marang-van de Mheen5, S Siesling2, M T F D Vrancken Peeters6. 1. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: e.heeg@lumc.nl. 2. Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands. 3. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands. 4. Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands. 5. Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands. 6. Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
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.
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 cancerpatients 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.
Authors: E Heeg; Y A Civil; M A Hillen; C H Smorenburg; L A E Woerdeman; E J Groen; H A O Winter-Warnars; M T F D Vrancken Peeters Journal: Ann Surg Oncol Date: 2019-10-11 Impact factor: 5.344
Authors: L S E van Egdom; K M de Ligt; L de Munck; L B Koppert; M A M Mureau; H A Rakhorst; S Siesling Journal: Breast Cancer Date: 2021-11-15 Impact factor: 4.239
Authors: E Heeg; J X Harmeling; B E Becherer; P J Marang-van de Mheen; M T F D Vrancken Peeters; M A M Mureau Journal: Br J Surg Date: 2019-08-06 Impact factor: 6.939