Department of Family Medicine, McGill University, Montreal, QC.
Department of Oncology, Division of Radiation Oncology, Supportive Cancer Care Research Unit, Hamilton, ON.
Curr Oncol. 2019 Feb;26(1):48-54. doi: 10.3747/co.26.4687. Epub 2019 Feb 1.
Traditionally, the role of primary care providers (pcps) across the cancer care trajectory has focused on prevention and early detection. In combination with screening initiatives, new and evolving treatment approaches have contributed to significant improvements in survival in a number of cancer types. For Canadian cancer survivors, the 5-year survival rate is now better than it was a decade ago, and the survivor population is expected to reach 2 million by 2031. Notwithstanding those improvements, many cancer survivors experience late and long-term effects, and comorbid conditions have been noted to be increasing in prevalence for this vulnerable population. In view of those observations, and considering the anticipated shortage of oncology providers, increasing reliance is being placed on the primary care workforce for the provision of survivorship care. Despite the willingness of pcps to engage in that role, further substantial efforts to elucidate the landscape of high-quality, sustainable, and comprehensive survivorship care delivery within primary care are required. The present article offers an overview of the integration of pcps into survivorship care provision. More specifically, it outlines known barriers and potential solutions in five categories: ■ Survivorship care coordination■ Knowledge of survivorship■ pcp-led clinical environments■ Models of survivorship care■ Health policy and organizational advocacy.
传统上,初级保健提供者(pcp)在癌症护理过程中的角色侧重于预防和早期发现。结合筛查计划,新的和不断发展的治疗方法为多种癌症类型的生存显著改善做出了贡献。对于加拿大癌症幸存者来说,目前的 5 年生存率比 10 年前要好,预计到 2031 年,幸存者人数将达到 200 万。尽管取得了这些进展,但许多癌症幸存者仍会出现晚期和长期影响,并且已经注意到这种弱势群体的合并症患病率正在增加。鉴于这些观察结果,并且考虑到预计肿瘤学提供者的短缺,初级保健劳动力在提供生存护理方面的依赖程度正在增加。尽管 pcp 愿意承担这一角色,但仍需要进一步作出大量努力,阐明初级保健中高质量、可持续和全面的生存护理提供情况。本文概述了将 pcp 纳入生存护理提供的情况。更具体地说,它概述了在五个类别中的已知障碍和潜在解决方案:
生存护理协调
生存知识
pcp 主导的临床环境
生存护理模式
卫生政策和组织倡导。