Don't overlook GPs role in cancer care

LETTER | I refer to the recent cabinet decision to turn down the request to harmonise general practitioner (GP) fees and the price control mechanism drugs.

I can’t help feeling saddened to hear that the plight of our health professionals is not being given due consideration by our policymakers. I would like to bring their attention to my practice in cancer care which is a multi-professional field in which oncologists, other site-specific specialists and general practitioners (GPs) all play a role especially in a resource-limited country such as ours.

Cancer management is a huge undertaking and a continuous public health challenge in Malaysia. While a shortage of oncologists looms, the demand for oncology services in our country is increasing. With a population of 34 million, the current ratio stands at 3.4 oncologists per one million Malaysian people. 

Optimum cancer health services can only be delivered via good policies and governance, integrated infrastructure and systems for awareness, prevention and early detection besides efficient and timely diagnoses, treatment and supportive care. 

Malaysian patients with cancer frequently present late with poor outcomes. The lack of nationwide effective prevention, poor access to specialised investigation and treatment as well as the use of unproven alternative medications for cancer have been commonly highlighted. However, inadequately tapped primary healthcare systems deserve a mention if we are serious about improving cancer care in our country.

Whenever the context of a growing cancer burden in our resource-limited country is discussed, the need to implement an integrated and multidisciplinary approach to cancer cares must be given priority. This is where the role of the GPs lies. 

Sadly, the need for a better understanding of the involvement of primary care physicians or GPs in cancer care is lacking. The GPs’ tasks within the broad cancer care spectrum may range from prevention, cancer screening and diagnosis, treatment of side-effects during definitive cancer therapy, shared follow-up and survivorship care, to bereavement and end-of-life care. This is the work of a professional the value of which should not be overlooked.

Let's take a look at the simplest example. One key aspect of the national strategic plan for cancer control is to promote a healthy lifestyle, prevention and early detection. The levels of cancer prevention effort - broadly classified into primary, secondary, and tertiary prevention - lies within the realm of public health. 

Various health education programmes, health awareness campaigns, and vaccinations are the basis for primary prevention followed by secondary prevention with health screenings and early detection of cancer with prompt initiation of treatment as the goal. 

In established cancer diagnoses, tertiary prevention focuses on reducing the impact of the disease with rehabilitation and improvement of patients’ quality of life. The general practitioner plays a huge role in implementing secondary prevention and they can be instrumental in the initial decision-making by the patient to go on the clinical pathway rather than the unproven treatment pathway.

Their clinical skills and rapport with their patients built over years may help patients to navigate through the healthcare system especially when the patients go through one treatment phase to the other. If the GP is not remunerated accordingly for their role, a lack of continuity in cancer care may result and erode the quality of a holistic cancer care process.

Early detection of cancers requires recognition of common symptoms and early warning signs of cancer. Not all patients have access to tertiary care in urban areas. In most corners within our country, the subsequent steps to be taken lie within the scope of the GPs. 

Mobilising appropriate resources in order to reduce the physical, social and psychological impacts of cancer on individual patients cannot be carried out with community pharmacists or be entrusted only to healthcare professionals within public health facilities. 

The "first-contact, continuous, comprehensive and coordinating care" by the GPs is indeed a challenge and this is definitely a role worth investing in. Not only that, in the future, GPs may do follow-ups on patients upon completion of treatment in cooperation with the oncologists and provide support for families and carers of cancer patients, including during bereavement. 

Recognising their value and fostering long-term planning for these primary care doctors to deliver efficient cancer care that is interconnected with us in the oncology field will ensure that patients’ needs are met throughout the cancer trajectory.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.