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Lancet Oncol. 2015 Sep;16(12):1231-72. doi: 10.1016/S1470-2045(15)00205-3.

The expanding role of primary care in cancer control.

Author information

1
School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK. Electronic address: g.p.rubin@durham.ac.uk.
2
Department of General Practice, University of Groningen, Groningen, Netherlands.
3
Airedale National Health Service Foundation Trust, Keighley, UK.
4
School of Clinical Sciences, University of Bristol, Bristol, UK.
5
Ontario Institute for Cancer Research, Toronto, ON, Canada.
6
Department of General Practice, University of Melbourne, Melbourne, VIC, Australia.
7
Royal College of Surgeons in Ireland, Dublin, Ireland.
8
Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
9
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
10
Medical School, University of Exeter, Exeter, UK.
11
Cancer Research UK, London, UK.
12
School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK.
13
Department of Epidemiology and Public Health, University College London, London, UK.
14
Hull-York Medical School, University of Hull, Hull, UK.
15
Faculty of Life Sciences and Medicine, King's College London, London, UK.
16
Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia.
17
North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales.
18
Glenfield Hospital, Leicester, UK.
19
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
20
Department of General Practice, Charles University, Prague, Czech Republic.
21
Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada.
22
Juravinski Cancer Centre, Hamilton, ON, Canada.
23
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
24
Department of Public Health, Aarhus University, Aarhus, Denmark.
25
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
26
Department of Clinical Health Care, Oxford Brookes University, Oxford, UK.
27
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
28
American Cancer Society, Atlanta, GA, USA.
29
Research Department of Oncology, University College London, London, UK.
30
Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
31
Department of General Practice, University Medical Center Utrecht, Utrecht, Netherlands.
32
Division of Medical Oncology and Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract

The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.

PMID:
26431866
DOI:
10.1016/S1470-2045(15)00205-3
[Indexed for MEDLINE]

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