Primary care and care for chronic cancer patients in Europe General comments to the Euroforum mother document Frank Buntinx,

1. Structure Paper is on ‘chronic cancer patients’, but: – chapter on screening – no chapter on role of PHC providers during initial treatment. Either ‘ cancer patients’ & include all stages or ‘chronic cancer patients’. This should be defined. Structure the paper according to the chronological sequence of different stages (including early diagnosis, caring during treatment, …), followed by some more general chapters (research agenda, cancer plans, …)

Structure IncidenceIncidence & background (co-morbidity) screeningPrimary prevention (?) and screening -Early diagnosis, referral and delays -Planning & execution of initial treatment Survivorship Role & organisation (weak !)- Co-morbidity, chronic cancer & survivors, Self management, carers - Palliative care -Role & organisation (+ self management) -Carers Cancer plans Data & researchResearch agenda

2. Cancer = disease of old age people Age at diagnosis:<50: 1/ : 3/7 >70: 3/7 Consequences: – Multimorbidity and frailty. Influence on the consequences of a malignancy and on fitness for cancer therapy (effect of treatment, likelihood and degree of side-effects ). Cancers and their treatments will influence prognosis & treatment opportunities for co-morbid diseases. – frequently living alone – more difficulties with dealing with treatment practicalities. – Prevalent co-morbidity vs. subsequent morbidity.

3. Chronic disease  reintegration to work This is new  causing problems to patients and clinicians, but also insurance physicians, human resource officers, trade unions. Cancer survivors may be willing to reintegrate, but not always full time & at the same rhythm as before. Others may have taken over the job. PHC: intermediary role in polishing the gradual transition from seriously dangerously ill to becoming active again?

4. Collaboration with secondary care A chapter on the relation between primary and secondary care can hardly be missed. Quick & easy referral opportunities for possible cancer patients (also see the NHS targets). Organizing influence of the GP on important treatment decisions, also while in hospital. Inclusion of the GP in the care team during chemotherapy or radiotherapy, so preventing the relation between GP and patient to fade away.

5. Cancer plans In many countries, there is no specific role for PHC workers. Cancer control is almost totally hospital based, with PHC available to fill the holes and to provide some palliative care. Propose which items should be included in or added to a national cancer plan.