Nonreferral of nursing home patients with suspected breast cancer

Abstract

Introduction: People with suspected breast cancer who are not referred for diagnostic testing remain unregistered and are not included in cancer statistics. Little is known about the extent of and motivation for nonreferral of these patients.

Methods: A Web-based survey was sent to all elderly care physicians (ECPs) registered at the National Association of Elderly Care Physicians and Social Geriatricians in the Netherlands, inquiring about the number of patients with suspected breast cancer they encountered and subsequent choices regarding referral.

Results: Surveys were completed by 419 (34%) of 1239 ECPs; 249 (60%) of these had encountered one or more patients with suspected breast cancer in the past year. Seventy-four (33%) ECPs reported not referring the last patient. Reasons for nonreferral were end-stage dementia (57%), patient/family preference (29%), and limited life expectancy (23%). Referral was frequently thought to be too burdensome (13%). For 16% of nonreferred patients, hormonal treatment was started by the ECP without diagnostic confirmation of cancer.

Conclusion: In this survey, more than 33% of nursing home patients with suspected breast cancer were not referred for further testing, in particular those with advanced dementia, limited life expectancy, and poor functional status. As the combination of dementia and suspected breast cancer is expected to double in the coming decades, now is the time to optimize cancer care for these vulnerable patients.