Themes of work
Because primary care is involved in cancer care across the continuum from prevention to end of life care we encourage research in seven key areas.
It is estimated that up to a third of cancers are preventable, and hence cancer control efforts must include lifestyle advice to encourage individuals to modify potentially damaging behaviours.
Primary care is well placed to contribute to these efforts, including in the provision of smoking cessation services and advice on physical exercise and diet, although there is a need for further work on the most effective interventions for each of these factors.
Primary care plays a central role in the delivery of cancer screening to patients, whether in support of organised screening programmes at a national or regional level, or opportunistic approaches to individuals accessing health care services.
Systematic reviews examining the evidence for strategies to increase participation in screening have identified a number of effective primary care-based approaches (such as endorsement by a family practitioner, or telephone counselling).
However, strategies to improve uptake typically produce only incremental increases and there is a need to further develop an evidence base for effective interventions for diverse populations, ideally informed by comparative studies in and across different health care settings.
It is recognised that primary care has a crucial role to play in awareness raising of cancer symptoms, responding to symptoms as they present in primary care and undertaking appropriate and timely investigations and referrals.
Symptoms of cancer are very common in primary care, and there is an emerging body of evidence underpinning more effective and comprehensive cancer risk assessment.
This includes the use of new diagnostic algorithms based on symptoms and risk factors. Further, there is much to be gained from comparisons of the cancer diagnostic process in different contexts and countries.
Treatment and survivorship
Although cancer care has traditionally been provided in secondary care, the role of primary care during- or in follow-up following initial treatment is the focus of a great deal of interest in many countries, including the development and comparison of models of follow-up for those patients where monitoring for recurrence and addressing psychosocial issues can be effectively and safely delivered the primary care.
Similarly, as the number of patients living with and beyond cancer is increasing globally due to changes in population demographics and improved cancer rates, the health care needs of this patient group are increasingly recognised as is the role of primary care cancer in contributing to the provision of patient-centred information on dealing with physical, psychosocial as well as financial and family concerns.
End of life care
Primary care provides palliative and end of life care to the majority of cancer (and non-cancer) patients throughout the world; there have been a number of important initiatives in several countries in recent years to strengthen the evidence base for this aspect of care.
However, there is a continued need for better clarification and standardisation of definitions of end of life care. Models of good practice need to be developed and evaluated.
Conceptual and methodological issues
There is a growing recognition that international high-quality research in early diagnosis of cancer is hindered by a lack of consensus on definitions and methods used in early diagnosis research. For example, there is no widespread agreement on defining “time to diagnosis” or how to measure it.
There are challenging measurement and methodological issues in this kind of research – such as recall bias, dealing with long-term symptoms and asymptomatic presentation. Existing literature uses a variety of definitions and methodological approaches to early diagnosis research making international comparisons difficult.
To address this need for consistency in terminology and methods a number of Consensus Working Groups have been proposed in areas including early diagnosis and survivorship, achieving consensus and consistency in methodological approaches which will underpin future international collaborative research efforts.
Communication, decision making and care coordination
Primary care providers have a vital role in communicating cancer risk to patients with or without symptoms. A variety of mechanisms exist to underpin risk communication in primary care and further evidence is required to identify the most effective strategies.
Further, sharing of clinical information between various healthcare providers is a vital element of effective cancer control.
There is evidence from many countries around the world of delays in cancer diagnosis arising from poor communication and again more research and evidence is needed to address these issues.
Cancer treatment decision are increasingly complex, since advancements in treatment options have facilitated opportunities for personalised cancer care. As a health care professional with unique knowledge of a patient’s personal and medical situation. We study the optimal way to involve the GP in shared decision making.