Cancer care: primary care doctors are ill-prepared

Photo: Primary care doctor talking to a patient

The authors identify a range of measures that need to be introduced to better integrate primary and secondary care, and to ensure that primary care doctors have the necessary information and skills to fulfill their critical role in cancer care; © Wodicka

Leading primary care professionals and cancer experts warn that primary care doctors will not be able to cope with the rising demand for cancer care in high-income countries - predicted to double within the next 15 years. But with radical improvements in diagnostic services, cancer education and training, and policies that encourage integration between primary and specialist care, primary care doctors could hold the key to meeting this growing demand for cancer care.

The major new The Lancet Oncology Commission, led by Greg Rubin, Professor of General Practice and Primary Care at Durham University in the UK, and until recently the first ever Clinical Lead for Cancer for the RCGP, states that with governments increasingly turning to primary care to play a larger role in health care, the grand challenge is how to equip doctors to fulfill this role effectively for cancer.

"Cancer control in high-income countries has mainly focused on highly technical treatments intended to save or prolong life, while the contribution of primary care has been seen as marginal. However, with the growing emphasis in recent years on early diagnosis and on the patient experience during and after treatment, the vital role of primary care doctors has become clear," says Professor Rubin.

He adds, "With an ageing population and a rapidly increasing number of cancer survivors, the primary care cancer workload will increase substantially over the next 10 years. Our challenge is how to prepare primary care doctors as the cornerstone in prevention, early detection, survivorship, and palliative care."

People with cancer and their families want care that is accessible, close to home, continuous, and coordinated--with a seamless journey between different care settings such as primary care practices, hospitals, cancer centers, and palliative care services. Yet, surprisingly, in many countries primary care doctors have no formal role either during treatment or in the after care of people with cancer, and are often bypassed when palliative care is required.

The Commission calls for much more effective integration between primary and specialist (hospital) care. Evidence from the USA shows that long-term cancer survivors who see both primary care doctors and oncologists are more likely to receive the full array of care they need. Other research done in the UK, Canada, and Australia reports that integrated after care of cancer survivors improved patient satisfaction, with no differences in recurrence or survival, and at lower cost.

The authors point out that while demand for cancer care is predicted to increase by 40 percent over the next 20 years, the number of oncologists is only expected to grow by 25 percent. "It is too simplistic to assume that providing more oncologists is the solution," says Professor Rubin. "It is the way that health care providers work together that holds the key to meeting this need. Hospitals, primary care doctors, and other community partners need to be better coordinated for after care, survivorship, and end of life care, so that patients receive good quality care, outcomes improve, and inequalities are reduced."

According to Professor Rubin, "Primary care doctors are expert generalists who provide continuous and comprehensive care to patients and their families, and do this in the context of the patient's social and domestic circumstances. As such they have much to offer people with cancer, and should be enabled to do so."; Source: The Lancet

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