Family Physicians Increasingly Taking Role of Coordinator of Cancer Care, ACS President Says

SAN FRANCISCO—In an era of increasing fragmentation and specialization in cancer care, and a trend toward ambulatory care, the family physician’s role as a coordinator of care is more important than ever—for both patients and cancer specialists, David Rosenthal, MD, president of the American Cancer Society (ACS), said at the American Academy of Family Physicians meeting.

Not only is the family physician vital in detecting the disease, but also in helping ensure quality of life and support for cancer survivors and their families . “Today, there are more than 10 million cancer survivors facing an array of psychosocial, family, and financial issues,” said Dr. Rosenthal, director of Health Services at Harvard.

Role of the Family Physician in Cancer Care

Diagnosing

Delivering physical care and treatment

Educating patients and family members

Assessing psychosocial strengths and re- ferring for needed services

Offering emotional support

Assisting in maintaining positive outlook

Advocating for best care

Adapted from Clark EJ, Stovall EL: Cancer Practice, Sept/Oct 1996.

The American Cancer Society has established three goals for the year 2015: a 25% reduction in overall cancer incidence, a 50% reduction in cancer mortality, and better quality of life for all cancer survivors.

“Many of the concerns of physicians in achieving these goals center on how to follow cancer patients and screen for cancer,” Dr. Rosenthal said. He noted that follow-up guidelines for certain cancers are controversial. “But we certainly need to integrate a patient’s cancer history into our wellness programs—programs that can be centered around the family physician’s office,” he said.

Family physicians are also more likely to take on the role of social worker with cancer survivors, helping to answer questions and arrange for psychosocial support. Many cancer patients are filled with questions ranging from “How much pain will I have?” to “Why am I depressed?” Dr. Rosenthal said.

Well-validated quality of life studies by the ACS and other organizations also show that cancer survivors face many common problems—fatigue, loss of strength, fear of recurrence, and sleep and sexual performance difficulties. “We need to offer these patients more supportive care with the goal of making them feel and function better,” he said.

Family physicians also need to be aware of the growing interest among cancer patients in complementary therapies, such as vitamins, relaxation therapy, special diets, and meditation, he said, noting that 72% of cancer survivors have used at least one of these therapies. “Not only do we need to urge our patients to stay in the mainstream for treatment with evidence-based therapies, but we need to encourage them to talk to us about their use of alternative and complementary therapies,” Dr. Rosenthal said.

Certainly, the family physician has to be an integral part of the cancer treatment team, he said. The family doctor often diagnoses the cancer and makes sure that the patient receives care for treatment side effects. The family physician may also act as a detective, piecing together clues about whether symptoms during treatment are related to the cancer, the treatment, or another cause.

Family physicians may feel uncomfortable dealing with patients undergoing newer cancer therapies, he said, “but at the same time, the family physician knows the patient best. That’s why family physicians can help provide the cancer patient with more integrated care, as well as offer the patient hope and be his or her advocate for the best care possible.”