GPs are inadequately equipped to manage growing demand for cancer care, study warns

GPs are inadequately trained and resourced to manage the growing demand for cancer care in high income countries, an expert review has warned.

The report, published in the Lancet Oncology, highlighted the gap between the expectation from governments and health funders that healthcare will increasingly be managed in primary care and the predicted doubling of the need for cancer care over the next 15 years.1 A primary care doctor with 2000 patients currently has around 70 patients with or surviving cancer, but this will double to around 140 patients by 2040.

Representatives from primary care and specialists in health policy and cancer met to review the evidence for the effectiveness of measures for cancer prevention, early diagnosis, and patient care during and after treatment in primary care and community care settings. They looked at how cancer care might be delivered differently in the future and the implications for the training of doctors and for primary care resources.

The commission found that, even though people with cancer want care that is accessible and coordinated, primary care doctors in many countries currently have no formal role either during treatment or in the after care of people with cancer.

“Cancer control in high income countries has mainly focused on highly technical treatments intended to save or prolong life, while the contribution of primary care has been seen as marginal. However, with the growing emphasis in recent years on early diagnosis and on the patient experience during and after treatment, the vital role of primary care doctors has become clear,” lead author Greg Rubin, professor of general practice and primary care at Durham University, said in a statement.

“With an ageing population and a rapidly increasing number of cancer survivors, the primary care cancer workload will increase substantially over the next 10 years. Our challenge is how to prepare primary care doctors as the cornerstone in prevention, early detection, survivorship, and palliative care,” he said.

The review identified several measures that could better equip GPs to manage cancer care in the community. These included better integration between primary and hospital specialist care with greater communication with specialists and easy referral back to hospital care; new models of shared care between primary care and oncology; better access to diagnostic tests; education and support for developing knowledge and skills in cancer, including in undergraduate medical training; and robust monitoring systems for detecting recurrence and adverse effects of treatments.

Commenting on the review, which will be launched this week at the annual conference of the UK Royal College of General Practitioners, Richard Roope, cancer lead for the RCGP, said in a statement, “We need to see significant investment in general practice, including more GPs, as a matter of urgency, so that we can contribute to preventing cancers and, where this is not possible, ensure patients receive the care they need at every stage of their condition.”