title: The expanding role of primary care in cancer control.
abstract: The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK. Electronic address: g.p.rubin@durham.ac.uk.
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
authors.affiliation: Department of General Practice, University of Groningen, Groningen, Netherlands.
authors.forename: Annette
authors.initials: A
authors.lastname: Berendsen
authors.affiliation: Airedale National Health Service Foundation Trust, Keighley, UK.
authors.forename: S Michael
authors.initials: SM
authors.lastname: Crawford
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dommett
authors.affiliation: Ontario Institute for Cancer Research, Toronto, ON, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Earle
authors.affiliation: Department of General Practice, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Emery
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
authors.affiliation: Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Grassi
authors.affiliation: Ontario Institute for Cancer Research, Toronto, ON, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Sumit
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Medical School, University of Exeter, Exeter, UK.
authors.forename: Willie
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: Cancer Research UK, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Hiom
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK.
authors.forename: David
authors.initials: D
authors.lastname: Hunter
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
authors.affiliation: Hull-York Medical School, University of Hull, Hull, UK.
authors.forename: Una
authors.initials: U
authors.lastname: Macleod
authors.affiliation: Faculty of Life Sciences and Medicine, King's College London, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Mason
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Geoffrey
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authors.lastname: Mitchell
authors.affiliation: North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
authors.affiliation: Glenfield Hospital, Leicester, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Peake
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.affiliation: Department of General Practice, Charles University, Prague, Czech Republic.
authors.forename: Bohumil
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Sisler
authors.affiliation: Juravinski Cancer Centre, Hamilton, ON, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sussman
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Taplin
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Teja
authors.initials: T
authors.lastname: Voruganti
authors.affiliation: Department of General Practice, University of Groningen, Groningen, Netherlands.
authors.forename: Fiona
authors.initials: F
authors.lastname: Walter
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Department of Clinical Health Care, Oxford Brookes University, Oxford, UK.
authors.forename: Eila
authors.initials: E
authors.lastname: Watson
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: David
authors.initials: D
authors.lastname: Weller
authors.affiliation: American Cancer Society, Atlanta, GA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Wender
authors.affiliation: Research Department of Oncology, University College London, London, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Whelan
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Whitlock
authors.affiliation: North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales.
authors.forename: Clare
authors.initials: C
authors.lastname: Wilkinson
authors.affiliation: Department of General Practice, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Niek
authors.initials: N
authors.lastname: de Wit
authors.affiliation: Division of Medical Oncology and Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: D003695:Delivery of Health Care / Q000379:methods*; D006301:Health Services Needs and Demand; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D011320:Primary Health Care / Q000379:methods*