Study Explores Care FPs Provide to Patients With Cancer

Do oncologists, surgeons and their teams almost exclusively provide medical care to patients with active diagnoses of cancer, or do family physicians also directly provide care? Empirical studies say little about primary care physicians' involvement in caring for such patients, but in reality, patients can expect a lot from their family physicians, suggests an study presented in the February issue of Family Medicine.

The report, "Physicians' and Patients' Views of Cancer Care by Family Physicians: A Report From the American Academy of Family Physicians National Research Network," (PDF file: 6 pages / 173 KB. More about PDFs.) analyzes telephone interviews with 15 FPs and 15 of their patients with cancer. "There has been little research describing the role of family physicians in the care of patients with an active diagnosis of cancer," say the authors, led by John Hickner, M.D., M.Sc., a professor of family medicine at the University of Chicago and former director of the National Research Network.

In this qualitative study, a preliminary step to larger studies, the researchers say they aimed "to begin an exploration of the landscape of care" that FPs provide to patients with active cancer diagnoses. The interviews were open-ended, not all physicians or patients were asked the same questions, and the subjects' spontaneous responses became content for the researchers' analysis. The physicians in the study answered questions pertaining to their entire panel of patients with cancer, not just about the single patient each had nominated to participate in the study.

The FPs studied reported giving a broad range of care. All 15 physicians said they played some role in pain management and participated at some level in the terminal care of their cancer patients. Thirteen physicians were asked whether they made home visits to their patients with cancer, and 12 said yes. "We found family physician involvement to be more intensive at the beginning and end of treatment (diagnosis and referral and terminal care or resumption of regular care after cancer treatment)," say the authors.

Twelve of the 15 patients said they saw or communicated with their family physicians regularly. Ten of the 15 patients volunteered the information that their FPs were understanding, caring and supportive; eight patients mentioned they were comfortable with their FPs. The researchers say they identified "considerable variability" among patients in their desire to have their primary care physicians involved in active cancer care and in the level of involvement the patients said their FPs had. "Yet some aspects of care were addressed by nearly all of those we interviewed," say the authors.

In their conclusion, the authors note, "Our data suggest that one size does not fit all. Patients' needs vary, and primary care physicians need to be flexible." The data, they add, "suggest that cancer patients should expect to receive competent general medical care, advice regarding treatment, care coordination, pain management, and end-of-life care and emotional support from their primary care physicians."