The American Academy Family Physicians supports the Institute of Medicine’s 2013 report, “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis,” and its recognition of the need for an integrated workforce to address the needs of cancer patients. The role of the family physician should be at all stages of cancer care: cancer diagnosis, referral for specialty care, co-management with specialty care, survivorship management and palliative care before the last six months of life and including hospice care. The following elements of quality care should be accessible for each individual with cancer:
Cancer Diagnosis: Patients should have healthcare access to ensure evidence-based screening and early identification of cancer.
Referral for Specialty Care: Patients should have affordable and accessible options for care. Accurate staging and prognosis should be completed and communicated in language that patients can understand. Treatment options should be presented with a clear explanation of benefit and expected side effects. There should be written communication back to the referring family physician.
Co-management with Specialty Care: The cancer-care workforce should include family physicians and other physicians who can work as part of the care-team for the cancer team. There should be transparent communication between members of the health-care team. An enhanced information system may be able to facilitate this. Co-management should recognize complexity and cost of care and work toward adherence to cost-effective, evidence-based treatment algorithms.
Survivorship Management: Patients should have access to appropriate surveillance and screening tests specific to the cancer they have had, and the anticipated long-term side effects of treatments they have received. The physician workforce, including family physicians, should be educated about the protocols for survivorship management. When possible a transition of care document could be issued to clarify who will be conducting the ongoing surveillance and recommended testing.
Palliative Care: Patients should have access to palliative care before the last six months of life, concurrent with active treatment as well as conventional hospice care. Patients should be engaged and informed of their choices. Patients should be given accurate information about their prognosis and this should be included in documents which are shared with other team-members.
(May 2016 BOD)