The Lancet Oncology CommissionThe expanding role of primary care in cancer control
Section snippets
Part 1: Introduction
Cancer control in high-income countries has long been dominated by highly technical, disease-centred interventions intended to save or prolong life. This is changing as health policies drive an increased emphasis on public awareness, screening, and early diagnosis of symptomatic disease as a means to further improve outcomes. At the same time, more people are surviving cancer and will live with the long-term effects of their disease and its treatment. This is not a unique problem for the
Part 2: Prevention, screening, and promotion of help-seeking
PCPs are at the front line of health-care services and have important roles in primary prevention and screening for cancer. In this section, we review the evidence for the effectiveness of their involvement, although these efforts should be ideally coordinated with broader public health efforts.
Part 3: Early diagnosis in children, teenagers, and young adults
Cancer is the leading cause of disease-related death in children in high-income countries. The prompt and early diagnosis of cancer in children, teenagers, and young adults (younger than age 25 years) has long been of concern to caregivers, physicians, and policy makers. In this section, we review the effect of prolonged times to diagnosis, common presentations of cancers arising in this age period, the role of PCPs in the diagnosis of such malignancies, the challenges they face, and possible
Part 4: Early diagnosis in adults
Even for cancers for which screening programmes exist, the great majority of cases present symptomatically in primary care. Most patients with symptoms that could signal cancer have a benign cause. PCPs should assess the probability of cancer in these patients, their need for referral for further investigations, and the urgency with which referral and investigation should be done. The conceptual framework (pathways to treatment; figure 3) within which diagnosis of cancer should be considered
Part 5: Cancer survivorship care
The number of cancer survivors is rising rapidly, mainly as a result of improvements in cancer outcomes because of advances in screening, early diagnosis, and treatments for cancer, coupled with an increased number of cases resulting from an ageing population. In the UK, for example, roughly 2 million people (around 3% of the population) are cancer survivors, and this number is predicted to rise to 4 million by 2030.4 Traditional models of follow-up in which patients continue to attend hospital
Part 6: Palliative care in advanced cancer
A third of patients diagnosed with cancer will die from their disease.203 The conceptual approach to the transition from curative to palliative treatment has changed from occurring at a discrete point in time to being a gradual introduction of hoping for the best, but preparing for the worst. As the chance of cure diminishes, oncology treatments have less of a role and palliative care becomes more important. Patients frequently want to spend most of their time at home, and most express a
Part 7: Integration of primary and specialist care
Integration of services between primary and specialist care is vital to optimise the quality and outcomes of care,253 but is known to be problematic.254 Patients often need to consult many health professionals across several health-care settings, which can lead to fragmented and uncoordinated care,193, 254 jeopardising care quality and patient safety.255 Accordingly, introduction of models and tools to improve integration is essential to optimise the role of primary care along the breadth of
Part 8: Health policy on primary care and cancer control
While the incidence of cancer is increasing, partly as a result of a rapidly growing ageing population, the number of cancer survivors is also increasing because of improvements in diagnosis and treatment. However, these gains are not experienced in every health system or social group, with some countries performing much better than others and some population groups having better care and outcomes than others. The reasons for this variation are complex and, for the most part, remain poorly
Part 9: Equipping primary care for its growing role in cancer care and control
Barton and colleagues316 discussed cancer as a growing public health problem and emphasised the crucial role of PCPs in providing patient-centred care for people affected by cancer. PCPs are involved across the cancer care continuum from screening to end-of-life care. A 2009 survey of PCPs in the USA showed that more than 90% provided general medical care for people with cancer, more than half assisted patients with decisions about treatment options and use of surgery, and 19% reported heavy
Part 10: Conclusions and recommendations
Primary care is continuous, coordinated, and comprehensive care for individuals and families, from the first contact for health care through to the end of life. It is an integral part of the care of all disease and at different stages of an illness. Crucially, the PCP works at the key interface between the patient and specialist care, facilitating timely and appropriate access and sometimes protecting the patient from unnecessary or inappropriate interventions. At the same time, the PCP is the
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