Download the role of gps in cancer care

THE ROLE OF GPS IN CANCER CARE
Prevention
GPs and other primary healthcare professionals are well placed to provide advice and support to
help people reduce their risk of cancer. This includes helping individuals to understand the holistic
impact of obesity, smoking, exercise and alcohol on their health and supporting interventions to
encourage healthy behaviours.
Even brief interventions such as those recommended by the National Institute of Health and Care
Excellence (NICE) for smoking cessation i have been shown to be effective in encouraging lifestyle
change.
It is important that primary care services have access to the information and resources to support
open discussion about risk factors for cancer and about evidence-based interventions that can
reduce risk.
Screening
Primary care has a direct role in taking samples for cervical screening. There is also a role for primary
care in breast and bowel screening programmes. A GP will often be the first port of call for patients
with questions or concerns about screening. Screening tests, while saving lives through early
detection, are not perfect. There are risks of false negatives and positives, with a risk that some
lesions / changes may be investigated and treated when they would not have progressed to cancer.
Some screening interventions themselves may also carry some risks (e.g. exposure to radiation from
mammography). It is important that primary healthcare professionals are able to help patients make
informed decisions and choose whether screening is right for them.
Early diagnosis and referral
Primary healthcare professionals have a critical role in early diagnosis of cancer through recognition
and prompt referral of people with symptoms that could be cancer for further testing or specialist
consultation. It is critical that primary healthcare professionals use clinical judgement in addition to
following relevant guidance.
Of course, early diagnosis is not simply the remit of primary care. Patient awareness, reporting of
symptoms and speed of assessment and diagnosis in secondary care all contribute. However, whilst
we can all play a role in increasing public awareness of symptoms, inevitably there will be patients
who do not present early, or are not referred at the first contact. In these cases, effective safety
netting and willingness to reconsider initial diagnoses are essential.
Living with and beyond cancer
It is essential that those working in primary care have a good understanding of the expected and the
unexpected symptoms from cancer and its treatment so that they are able to reassure, support,
treat, refer and signpost patients appropriately.
Although most oncology emergencies cannot be managed in primary care, it is essential that primary
healthcare professionals can recognise these conditions and manage or admit them appropriately. In
the majority of cases, malignant spinal cord compression, hypercalcemia, neutropenic sepsis and
superior vena cava obstruction, in the majority of cases need immediate admission although there
are always some exceptions.
It is also important to remember that patients who have had a cancer diagnosis have an increased
lifetime risk of developing another cancer. GPs should be proactive in lifestyle advice in those living
with or beyond cancer and be alert to symptoms of recurrence or second primary cancers.
End of life care
Proactive compassionate end of life care is a vital part of the cancer care pathway and information
on this can be found in the Palliative and End of Life toolkit.
i
Smoking: brief interventions and referrals: NICE guidelines [PH1] Published date: March 2006