Primary care doctors will not be able to cope with the rising demand for cancer care in high-income countries, which is 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. This warning came from leading primary care professionals and cancer experts at the Royal College of General Practitioners (RCGP) Annual Conference in Glasgow, United Kingdom.
Governments are increasingly turning to primary care to play a larger role in health care. So, the grand challenge is how to equip doctors to fulfill this role effectively for cancer. These conclusions came from the major new The Lancet Oncology Commission, led by Greg Rubin, FRCGP, professor of General Practice and Primary Care at Durham University in the United Kingdom. The findings were published in The Lancet Oncology (2015; 16:1231-1272).
“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,” said Rubin.
“With an aging 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.”
Half of all people with cancer now live for at least 10 years after diagnosis, up from just a quarter in the 1970s. According to the American Cancer Society, almost 14.5 million cancer survivors are alive in the United States today, and that number will grow to almost 19 million by 2024.
People with cancer and their families want care that is accessible, close to home, continuous, and coordinated. They seek 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 aftercare 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 United States 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 United Kingdom, Canada, and Australia reports that integrated aftercare of cancer survivors improved patient satisfaction, with no differences in recurrence or survival, and at lower cost.
“It is too simplistic to assume that providing more oncologists is the solution,” said 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 aftercare, survivorship, and end-of-life care, so that patients receive good quality care, outcomes improve, and inequalities are reduced.”