BOX 4-1The Roles of Primary Care Clinicians in Caring for Patients with Cancer
Primary care clinicians fulfill a diverse set of roles in cancer care. They are often the first clinicians that patients see when they have signs or symptoms of cancer and are the most likely to screen their patients for cancer. Thus, they are usually the ones diagnosing cancer and providing patients with referrals to oncologists or other specialists for treatment.
During active cancer treatment, primary care clinicians provide patients with ongoing health promotion, disease prevention, health maintenance, counseling, education, and diagnosis and treatment of other acute and chronic illnesses. This is especially important in older adults with cancer who tend to require treatment for other chronic conditions, such as high-blood pressure and diabetes (Unroe and Cohen, 2012).
It is important for the cancer care team to effectively coordinate with a patient's primary care clinicians during the acute cancer treatment phase. Primary care clinicians often have known their patients longer than the cancer care team and are more likely to be familiar with their patients' needs, values, and preferences. It is also important that primary care clinicians be informed about their patients' cancer treatments. They often provide continuous treatment for their patients' concurrent illnesses and conditions, which may need to be adjusted or monitored differently during cancer treatment, as well as survivorship care and cancer surveillance after their acute cancer treatment is complete. Primary care clinicians can also play a role during active treatment in establishing advance directives and coordinating with family caregivers and direct care workers (IOM, 2011b; Klabunde et al., 2009).
Cohen (2009) has described the ideal relationship between the primary care team and the cancer team as “shared care,” where both care teams are involved in a patient's care during the entire continuum of the disease, but have a bigger or smaller role at a given time depending on the needs of the patient and the disease status. In a survey by Del Giudice and colleagues, primary care clinicians reported that they are interested in being involved in their patients' cancer care, especially if they have a long-term relationship with the particular patient, but often feel they lack the preparation and knowledge to do so effectively (Del Giudice et al., 2009). A more recent survey by Potosky and colleagues (2011) found that primary care clinicians differ significantly from oncologists in their knowledge, attitudes, and practices related to follow-up care for breast and colon cancer. Cancer care plans which summarize a patient's needs, treatment information, and follow-up care, are tools to aid primary care clinicians in coordinating with the cancer care team and providing complementary health care services to their patients (see discussion on care plans in Chapter 3) (IOM, 2005, 2011b).
