Family physicians are uniquely positioned to provide comprehensive care of patients across the cancer care continuum. Their longitudinal relationship with patients allows them to address cancer-related issues in addition to chronic disease management, preventive care, psychosocial needs, and caregiver support. Maintaining awareness of a patient's cancer diagnosis and related treatment is essential for evaluating new symptoms, recognizing treatment-related adverse effects, and identifying potential oncologic emergencies. Cancer treatment often complicates management of existing chronic illnesses, requiring close monitoring, medication adjustments, and attention to lifestyle factors and nutritional status. Goals of diabetes management include optimal glycemic control to prevent delays in oncologic surgeries, impaired wound healing, and difficulty in managing chemotherapy. Screening for cardiovascular disease should be performed for patients with cancer and known cardiac risk factors or oncologic treatment exposures known to cause cardiac complications. Consistent physical activity is recommended during cancer treatment to improve quality of life. Family physicians frequently serve as the first point of contact when patients experience adverse effects or complications from cancer therapies, many of which can affect physical function, mental health, and quality of life. Effective coordination between oncologists and family physicians is essential to ensure patients receive holistic, person-centered care.
Approximately 40% of men and women in the United States will have cancer in their lifetime, and most at some point will access medical care in primary care settings.1–4 The National Cancer Institute defines cancer survivorship as the continuum from diagnosis to the end of life.3,5 The continuous and trusted relationship that family physicians build with their patients uniquely positions them to provide whole-person care from initial diagnosis to treatment and survivorship.
Primary care physicians should be recognized as integral members of the care team, given their central role in managing the overall health of patients across the cancer continuum. Evidence consistently shows that regardless of cancer status, patients who maintain an ongoing relationship with a primary care physician experience lower mortality rates from cancer, cardiovascular disease (CVD), and respiratory conditions compared with patients who rely solely on specialty care.6 Stronger connections to primary care are associated with greater adherence to preventive health measures, including routine cancer screenings.7
It is critical that family physicians maintain awareness of which patients have cancer or a history of cancer, as well as treatment received, even if it is broad (eg, history of chemotherapy or radiation). Research shows that documentation rates of cancer history are as low as 7%, which may leave family physicians unaware of important medical history.8 Table 1 lists suggested questions for obtaining an oncologic history.2,9,10
This article focuses on care of patients who currently have cancer. The care of patients with a history of cancer was covered previously in American Family Physician.11
WHAT'S NEW ON THIS TOPIC
| A large national survey found that more than 90% of primary care physicians caring for patients with cancer manage comorbid chronic conditions, pain, psychological distress, and aspects of end-of-life care for patients receiving cancer therapy. |
| In a large national sample of more than 30,000 cancer survivors, patients with a history of cancer had a significantly higher prevalence of diabetes, hypertension, kidney and liver disease, and morbid obesity than those without cancer. |
| Eating a predominantly plant-based diet, completing at least 30 minutes of moderate-intensity exercise 5 days per week, and maintaining a body mass index less than 25 kg/m2 are associated with lower risk of cancer recurrence and mortality, especially in survivors of colorectal, breast, and prostate cancers. |
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