The role of primary care in early detection and follow-up of cancer

Abstract

Primary care providers have important roles across the cancer continuum, from encouraging screening and accurate diagnosis to providing care during and after treatment for both the cancer and any comorbid conditions. Evidence shows that higher cancer screening participation rates are associated with greater involvement of primary care. Primary care providers are pivotal in reducing diagnostic delay, particularly in health systems that have long waiting times for outpatient diagnostic services. However, so-called fast-track systems designed to speed up hospital referrals are weakened by significant variation in their use by general practitioners (GPs), and affect the associated conversion and detection rates. Several randomized controlled trials have shown primary care-led follow-up care to be equivalent to hospital-led care in terms of patient wellbeing, recurrence rates and survival, and might be less costly. For primary care-led follow-up to be successful, appropriate guidelines must be incorporated, clear communication must be provided and specialist care must be accessible if required. Finally, models of long-term cancer follow-up are needed that provide holistic care and incorporate management of co-morbid conditions. We discuss all these aspects of primary care, focusing on the most common cancers managed at the GP office-breast, colorectal, prostate, lung and cervical cancers.

Knowledge, Attitude and Practice of Breast Cancer Screening among Female General Practitioners in Riyadh, Saudi Arabia

“…Primary care providers are pivotal in reducing diagnostic delay, particularly in health systems that have long waiting times for outpatient diagnostic services. Several randomized controlled trials have shown primary care-led follow-up care to be equivalent to hospital-led care in terms of patient wellbeing, recurrence rates and survival, and might be less costly [20].…”

Rethinking system change in cancer

“…As Emery et al note, there is significant variation in how providers implement referral pathways. 5 Implementation science recognizes that action is needed at an individual level and a system level in order to make a major change to models of care such as those described by Jefford et al in this issue. 8 Useful frameworks for designing change processes include the Knowledge to Action Cycle 9 , the United Kingdom Medical Research Council Complex Interventions Framework 10 and the Theoretical Domains Framework 11 for the assessment of barriers and enablers to change.…”

Budget Impact Analysis of a Breast Rapid Diagnostic Unit

“…Analyses of breast cancer diagnostic times in Canada have shown a general increase in wait time since the end of the 1990s 7,9 . That increase is attributed to an increased demand for services without a parallel rise in resources.…”

“…Furthermore, the diagnostic phase of breast cancer is an anxiety-provoking and stressful experience for the patient and the family 6 . Although published guidelines outline the appropriate diagnostic algorithms for breast cancer, few recommendations have addressed standardizing the timeliness with which such investigations should occur 7,8 .…”

“…Concerns about diagnostic delay, particularly in the context of a publicly funded health care system, have spurred the need for fast-track cancer referral routes 7 .…”