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EFPC Position Paper workshop
PC & Chronic Cancer
Nicosia, May 8, 2009
Danica Rotar – Pavlic, MD, PhD
Pim de Graaf, MD, MPH
European Forum for Primary Care
(EFPC)
Aim
• The workshop is aiming at
the professionals in
primary care who are
involved in cancer care
planning, teaching at
university or at practice
level.
• The aim of the workshop
is to work on “primary
care empowerment”
Specific questions
• What are new demands on primary care practitioners, in
terms of skills, tools, organisation and workload?
• In order to offer seamless care to patients, what examples
can we find of effective collaboration between PC teams
and secondary care?
• Do national cancer control plans address sufficiently
chronic cancer care and the needs of primary care ?
• Do practitioners need other/better support to be able to
offer palliative care?
• What adaptations and innovations occur in primary care
delivery to answer the shift in care need of cancer patients;
how do they take into account the needs of individual
patients and their domestic situation?
Structure of the workshop
• Introduction of participants
• Presentation of the draft version of PC & Chronic Cancer
(15 min)
• Identifying barriers, bridges and requirements – small
group discussion (20 min)
• Reports from the groups
• Building bridges, managing barriers and achieving
requirements - small group discussion (20 min)
• Reports from groups
• Confirming next steps and agreeing responsibilities
• End of the workshop
Introduction
Cancer mortality
• For men it was 166/100 000 in the old members of
EU, but in CEE (Central-Eastern Europe) countries
the number was between 195/100 000 (Lithuania) and
269/100 000 (Hungary)
• For woman it was 95/100 000 in the old members of
EU, but in CEE countries 98/100 000 (Lithuania and
Latvia), 120/100 000 (Czech Republic) and 138/100
000 (Hungary).*
*Dobrossy L:Cancer mortality in central-eastern Europe: facts behind figure,The Lancet Oncology,Vol 3,2002
Myths
A GP on average sees only one new case of lung cancer per
year. The core symptoms of lung cancer, cough and
dyspnoea, are, on the other hand, very common in general
practice which increases the risk of missing or delaying the
diagnosis.
“Missing” cancer during consultation in primary care may
affect credibility and self confidence of GP’s.
Myths have developed around this, like the idea that most
cancers present to the GP with symptoms and that cancer is
only considered or diagnosed in hospitals.
As a result, secondary care data has been used to drive
primary care decisions and little symptomatic diagnostic
research in primary care has been done until recently.
Survivorship and remaining problems
• Little attention has been given to the GPs‫ۥ‬potential
role in relation to cancer rehabilitation process and
the concept of survivorship.
• GPs often loose contact with the patients during
their cancer treatment after referral to further
diagnosing at hospital.
• After discharge from hospital, cancer patients
often feel “left in limbo” and do not know where
to seek help
Role and organisation of Primary Care
• Generalists should serve as an “ambassador for
patients in a foreign land”. This statement from
1998 refers to patients in the hospital environment
and reflects the view of many practitioners in
primary care. Currently, navigation is the preferred
term in primary care.
• Feed back to the GP during treatment and follow
up often is lacking or delayed. While this
phenomenon is widespread across Europe, some
examples do exist of active involvement of GP’s
and other staff in primary care, during the
treatment phase.
Follow-up and survivors
Routine follow-up care comprises:
• Surveillance for recurrence
• Surveillance for late effects of treatment, like
fertility issues.
• Surveillance for new primary cancer
• Psychosocial and mental health issues
• Special concerns (social/economic/occupational)
• In addition, general medical and preventive care
should be offered as to any other patient.
Palliative care
• One of the greater challenges
in palliative care possibly is in
ensuring that communication
between oncologist and
primary care – referral letter,
telephone contact – is
complete and timely.
• This should ensure coherent
information to and
communication with the
patient and the family and also
ensure that the GP participates
in the discussion about the
treatment options and
intentions.
Example from Denmark
• In Denmark, Warfvinge et al currently are
trying out a tele-home care and web-based
communication system in palliative care to
achieve precisely this: patient, family, GP
and specialist have the same views on what
purpose and practice of medication and
other elements of palliative care.
National Cancer Plan
• In the draft version of Slovenian national
cancer plan, special attention is given to the
basic responsibilities of primary healthcare
service providers in treating cancer.
• The rights of cancer patients and
responsibilities of primary healthcare
workers are not specifically defined.
Barriers
Barriers which are met by primary care doctors in Slovenia
are:
• Education in clinical oncology during residency is
insufficient (i.e., one month);
• The adopted guidelines do not define the role of primary
healthcare;
• Communication between the general practitioner and the
oncologist mostly takes place via referrals;
• Full-year referrals to an oncologist diminish the role of the
GP;
• The method of referring patients for rehabilitation from the
primary level is not optimal;
• Generally insufficient inclusion of the primary level in
palliative care.
Conclusion
EFPS is interested in
•
showing common
developments and new
challenges
•
diversity of approaches
and different initiatives
•
good practice in service
delivery
•
supportive policy
developments
•
research agenda
Important resources
• Edinburgh 2008
• Copenhagen 2009
• Nicosia 2009
Your contributions are highly valued