The ongoing care of patients with cancer: what is the appropriate balance of cancer between specialists and primary care?

Abstract
Background: Mortality rates have fallen resulting in people living longer with
cancer. However, cancer survivors can face significant treatment related
physical and psychosocial issues including comorbidities. Treatment related side
effects can persist in the long-term or may occur many years later. There is now
a focus on the best way to provide appropriate care to people who have survived
cancer and its treatment.

Aim: The aim of this study is to explore the appropriate balance of cancer care
for patients following diagnosis and treatment between specialist and primary
care.

Methods: Semi-structured interviews with a purposive sample of 40 oncologists,
CNSs and GPs across Scotland. Data are analysed in a systematic fashion using
constant comparison.

Findings: Many patients face significant health care issues after a diagnosis of
cancer. Professionals often play a pivotal role during follow-up by identifying
and managing patients’ physical and psychosocial needs and by sign posting to
address the challenges that arise. Psychosocial needs, long-term and late effects
are sometimes not addressed. Oncologists are leaders of the cancer care
process. CNSs often play a central role in survivorship both in specialist and
primary care. GPs’ roles are seen to span the full spectrum of survivorship care,
although this is largely opportunistic in nature. Communication between
specialist and primary care is a key issue. Professionals perceived that there is
insufficient contact across the interface in terms of understanding others’
viewpoints about the nature of their work. Efforts are needed to improve the
timeliness and detail of letters to primary care. Successful primary care followup
may require development of nurses’ roles in general practice and the
community. It is perceived that GPs could attend specialist care for survivorship
education or become cancer specialists in general practice. Cancer Care Reviews
are considered useful tools in terms of allowing GPs to engage with their
patients. Improvements to technology and further research are considered
central to optimal cancer care.
Conclusion: Considerable barriers exist with the current system of follow-up.
After the treatment phase, GP survivorship care is largely opportunistic and
driven by patients’ needs. Based on the findings from this study, strategies of
care could potentially be planned to facilitate the role of primary care.
However, research supporting these practices is needed.