The Family Physician’s Role in Cancer Care

Lilian White, MD
Posted on July 29, 2024

What is the role of the family physician in caring for patients who have experienced cancer? A recently published AFP article by Dr. Stephen Carek and colleagues noted patients who have survived cancer tend to have similar levels of recurrence, death, and health-related quality of life when routine follow-up is with their family physician compared with a specialist. In some cases, patients may even be more satisfied when follow-up care is with their family physician. The article outlines five integral components of care, including surveillance for cancer recurrence, screening for other primary cancers, managing effects of cancer treatment, addressing or preventing effects of treatment, and coordinating care with specialists. These components of care were originally developed by the National Academy of Medicine and are supported by the American Academy of Family Physicians (AAFP). Survivorship care plans have also been proposed as one way to improve communication between family physicians and specialists following cancer treatment.

The topic of caring for cancer survivors is particularly timely in light of the trend for screening for cancers earlier and earlier, which Kenny Lin, MD, noted is more a result of opinion than a decision founded in robust evidence. Overuse, or inappropriate use, of cancer screening is also a growing concern. The prevalence of patients who have survived cancer has increased over the years, from an estimated 15 million in 2016 to 26 million by 2040, perhaps related to increased cancer screening and detection.

What is the role of the family physician while a patient is actively being treated for cancer? It is helpful to consider the context of care and associated expectations. Independent physicians tend to report relationships with oncologists with “shared commitment, trust, and rapport” vs. the emphasis on sharing of patient information and timely referral noted by physicians within a health care system. Anecdotally, I’ve experienced the difference between caring for a patient diagnosed with cancer while in a health care system compared with independent practice (specifically direct primary care). In the system, my patient was given a timely referral and not seen until more than one year later following treatment. In my own practice, I saw the patient several times during cancer treatment to help with complications, talk through anxiety with testing and treatment, and discuss future plans in the context of the patient’s values. Therefore, the context of care may influence a patient’s care and interaction with their family physician.

A distinction between the two settings for patients and physicians may not always be clear, but it is a factor worth noting when discussing what is possible in the care of patients with cancer. As noted in the AAFP’s policy on cancer care, the “cancer-care team should include [both] family physicians and healthcare clinicians.” Whatever the specific role of the family physician is in cancer care, it behooves us to make it an active one.

A final note on wording: Not all of our patients will identify with the term “survivor.” In general, it is best practice to use person-first language as opposed to using diseases as adjectives. Rather than referring to someone as a cancer survivor, using phrasing such as “someone who has had cancer” is usually recommended for patients who have not expressed a preference. This excellent editorial by Elizabeth Kuper, MD, previously published in AFP, has additional information on communicating with patients who have cancer.

Patients without a history of cancer are also likely to benefit from being evaluated by their family physician on a regular basis. A study demonstrated that patients who saw their family physician annually had a lower rate of cancer-related death and metastasis at diagnosis. In keeping with our generalist roots, the family physician’s role in cancer care encompasses from prevention, diagnosis, and follow-up.