Skip to 0 minutes and 7 secondsWell, I think that the implications of survivors living longer with cancer really exemplify the important role of the primary care provider to be involved right throughout their trajectory. It's clear now that, in particular, some survivor populations who are not going to have cancer as their longevity-defining health event need family physicians and primary care teams to be involved in holistic health care and, in particular, to make sure that other chronic morbidity are maintained. In fact, it's interesting that for many cancers, while we think that surveillance is the most important activity, that often isn't the case.

Skip to 0 minutes and 49 secondsAnd individuals that spend too much time coming to cancer clinics and undergoing surveillance testing-- they're actually missing out on the benefits of a more holistic health care that is provided by primary care. So with patients living longer, I think there is an increasing role for the primary health care practitioner in their care, because they're not only dealing with cancer. They're also dealing with other morbidities. And if we only have follow-up care within the oncology clinic, that doesn't take into account all the other issues that a patient is facing and how they might interact with the cancer.

Skip to 1 minute and 25 secondsSo the GP or other health practitioners play a really vital role in making sure that all of those issues are looked at and taken into account. The ability to treat cancer more effectively has created a real surge in the number of cancer survivors in the US, and I'm sure here in Australia, which is a challenge for us who are trying to manage cancer survivorship more effectively based in cancer centre clinics. So we think there is a really important role, and big missed opportunities so far, in the idea that we need to do more cancer survivorship care in the primary care centre.

Skip to 2 minutes and 8 secondsWith patients living longer and earlier detection of people and the ageing of the general population, so that we are going to have basically a tsunami of cancer survivors, this will have huge implications on the primary health care system, as well as the tertiary health care system. So most importantly for the people at the primary is looking after the longer term issues that cancer survivors have and, in particular, looking for both side effects from the treatment and late-term effects of the treatment and, in particular, helping survivors to cope with the psychological aspects of the treatment-- so particularly things like very high levels of distress, fear of cancer recurrence.

Skip to 3 minutes and 1 secondAnd people at the primary level, including GPs, nurse practitioners, but also allied health, will have an incredibly large role to play in that. I think that the implications of patients living longer gives some pressure on the health care system in general. And if we talk about cancer survivorship, probably more particular for the primary care physician or general practitioner, as we would call that person in the Netherlands-- because survivorship care will be, I think in the near future, mainly be done by the GP and the nurse that is working in the GP office.

What are the implications of patients living longer with cancer?

Traditionally, Primary Care Practitioners (PCP) have played a secondary care role in the management of cancer patients. However, growing “survival rates and new models of care mean that the role of primary care is evolving, and a restructuring of cancer services to provide greater integrated care is now required” (Buckland, 2016, p.45).

“Cancer survivors are generally supportive of the concept of shared care to deliver holistic care after cancer and identify a number of key elements that would ensure effectiveness of shared care after cancer, including effective communication, care coordination and navigation, and shared medical records. They acknowledge that such an approach requires preparation of both survivors and their health professionals and a framework of care that supports measurement of outcomes” (Lawn, Fallon-Ferguson and Koczwara, 2017, p. 1089).

Having listened to the expert opinions in the video above, do you think the borders between primary and secondary care are viewed as too rigid? Do you think the advancement of targeted drugs, advanced diagnostics and new models of care influence better collaboration between disciplines, allowing PCPs a greater role in delivering oncology services to enhance patient experience and outcomes?

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Cancer Survivorship for Primary Care Practitioners

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