Despite continuing advances in clinical therapeutics, chemotherapy, radiotherapy, surgical interventions and various treatment modalities, cancer remains as the top cause of death in Hong Kong. According to Government statistics in 2009, malignant neoplasms accounted for 33.6% (n=7602) and 28.4% (n=5157) of all causes of death in male (N=22895) and female (N=18183) cancer death locally.¹ This is not unique to Hong Kong, as most developed countries would have by and large a similar trend. As family physicians, what roles can we play in managing patients with cancer?

As family physicians, we provide comprehensive continuing care for our patients in the community irrespective of their age, gender and stage in life. This is often described as from cradle to grave care. It is the very nature of our work that helps us to play a significant role in managing cancer patients. Watson² stated that family doctors could provide a wide spectrum of care to our patients, from primary prevention to early identification of cancer and to end of life care. McAvoy also reiterated that the general practitioner has an essential role to play in prevention, screening, detection, treatment and palliative care including the psychosocial wellbeing of patients as well as their carers.³ Managing psychological aspects of cancer patients is important as illustrated by Ma and Mak, depression is common among cancer patients and it can affect the patient’s compliance to treatment, quality of life, and increase the patient’s suicidal risk.⁴

According to the National Cancer Control Initiative 2003, despite the prevalence of cancer in many developed societies, the average primary care doctor would only have sixteen cancer patients with cancer under their care concurrently and see four newly diagnosed cancer patients within a twelve months’ period.⁵ Therefore, the majority of cancer related care provided by the family doctor belongs to preventive activities, helping patients to investigate suspicious symptoms and achieve early detection, managing their concerns and fear about potential cancer, and assisting patients to have lifestyle changes such as smoking cessation, and weight reduction for obese patients.³

Family physicians play a crucial role in health promotion and disease prevention.² Primary prevention strategies target patient’s modifiable risk factors before disease occurrence, aiming at protection against carcinogenesis.² Genetic counselling, vaccination against virus-related cancers, smoking cessation, alcohol reduction, avoidance of occupational carcinogens, Avoiding high – risk sexual activity, and dietary modification are highly relevant and applicable in general practice setting.² Secondary prevention aims at early detection of pre-malignant or early cancerous disease so that curative treatment can be given. ² Commonly practised national screening programmes include cervical cancer screening, breast cancer screening and bowel cancer screening.²

Another important role of the family physician is to be the patient’s ally and care navigator or coordinator throughout the patient’s journey. This is especially important for cancer patients because they need various specialist care and multidisciplinary care in different stages of their illness. After diagnosis is made, the cancer patient would likely be receiving intensive therapy provided by hospital specialists before returning to the community. The patient may also need continuing supportive treatment and rehabilitation for a period of time. At the end of life stage, the family physician with appropriate training and exposure would be in an excellent position to provide palliative treatment in the community setting. With an established excellent doctor-patient relationship based on long term trust and rapport, the family physician is well placed to be the care coordinator and patient’s advocate to guide, provide support and accompany the patient and his/her careers through this very difficult stage in life.