ASCO: Primary care physicians play a crucial role in diagnosis, survivorship of cancer patients

Diagnosis, screening, risk reduction, managing comorbidities, helping to coordinate specialty care, long-term toxicities, palliative care, survivorship, and vaccination are just a few of the roles for primary care physicians related to the diagnosis and care of cancer patients.

The message, delivered today during a panel discussion at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, sought to address myriad of challenges faced when coordinating care after a person is first diagnosed with cancer, during treatment, after care, and in survivorship.

“We are on the front lines for diagnosing cancer, coordinating treatment phases leading to survivorship, and end-of-life care,” says Larissa Nekhlyudov, MD, MPH, an internist and survivorship care provider at Dana-Farber/Brigham and Women’s Hospital in Boston.

Piyush Srivastava, MD, an oncologist for Kaiser Permanente in Walnut Creek, Calif., says survivorship studies have shown that Stage I and Stage II cancer patients are more likely to die from hypertension or modifiable risks like cigarette smoking than cancer. Who would you prefer to manage high blood pressure, diabetes, or other chronic diseases? “The answer is that the primary care physician needs to be an active member of the cancer-care team,” he says.

Consider that every 10 additional primary care physicians per 100,000 of population are associated with 51.5 days of additional life expectancy, versus 19.2 days for additional life expectancy with specialists. (JAMA Intern Med. 2019; 179(4) 506-514) 

Every 10 additional primary care providers per 100,000 of population are also associated with reduced cardiovascular, cancer and respiratory mortality.

As oncologic therapies advance, it signals a need to adopt a more collaborative approach to patient care, during treatment and when a patient enters remission.

Trevor Jolly, MBBS, a medical oncologist at the University of North Carolina at Chapel Hill, adds the primary care physician should serve as the medical quarterback. He encourages primary care physicians and oncologists to pick up the phone and communicate about cases and better collaborate on treatment decisions, especially for those patients undergoing chemotherapy or radiation.

“During treatment, patients tend to rely on the specialist,” Jolly says. “But in my office, we are referring back to the primary care physician.”

Elizabeth Shiff, a cancer survivor and patient advocate at the University of Cincinnati, says that when a patient is diagnosed with cancer, he or she is only thinking about next steps in the treatment plan. “It is important,” Shiff says, “to stress to the patient that his or her care will be like a triangle-between the oncologist, primary care physician, and patient.

“Empower your patients with communication about the treatment plan and the role of providers,” she adds.

Jolly agrees. “I think we need to have a more collaborative approach where treatment decisions are shared, especially with comorbidities and when hypertension or diabetes is uncontrolled.”

As cancer therapies advance, survivorship numbers have been climbing as well. Consider that 1.7 million new cases of cancer are diagnosed each year, but there are 16.9 million survivors. It signals a growing need for improved collaboration between oncologists and primary care physicians.