Review Article | Published:

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

Nature Reviews Clinical Oncology volume 11, pages 3848 (2014) | Download Citation

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.

Key points

  • Primary care providers have an increasingly important role in oncological services, particularly as the 'gatekeepers' to hospital-led services for the diagnosis and treatment of cancer

  • As cancer screening improves, primary care has a pivotal role in facilitating uptake, which can be enhanced using audit and feedback systems, office prompt systems and general practitioner endorsement

  • The epidemiology of cancer symptoms in primary care is becoming better understood, and risk models can be applied to identify patients requiring investigation for cancer

  • Fast-track referral routes might be a useful approach to reducing diagnostic delay in cancer, especially in health-care systems with long waiting times for out-patient diagnostic services

  • Primary care-led follow-up of breast and colorectal cancer is as effective as hospital-led care, but requires clear guidance for general practitioners, as well as good communication and access to specialists

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Affiliations

  1. General Practice and Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia.

    • Jon D. Emery
  2. University of Western Australia, General Practice, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.

    • Jon D. Emery
    • , Katie Shaw
    • , Briony Williams
    •  & Julia Fallon-Ferguson
  3. Monash University, School of Primary Health Care, Building 1270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia.

    • Danielle Mazza
  4. Cancer Institute of New South Wales, PO Box 41, Alexandria, New South Wales 1435, Australia.

    • Megan Varlow
  5. Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, New South Wales 2006, Australia.

    • Lyndal J. Trevena

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Contributions

J. D. Emery, K. Shaw, B. Williams, and L. J. Trevena researched the data for the article. All authors contributed to the discussion of the article's content, wrote the manuscript and edited it before submission.

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The authors declare no competing financial interests.

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Correspondence to Jon D. Emery.

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DOI

https://doi.org/10.1038/nrclinonc.2013.212

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