An American Family Physician review, published in October, sets out the work that falls to primary care while a patient is being treated for cancer. Family physicians are often the first contact when side effects or complications appear, and they continue to manage the patient's other conditions, prevention, mental health and carers.
The review highlights several specific tasks. Keep the diagnosis and current treatment in mind when assessing any new symptom, so that oncological emergencies and drug effects are recognised. Keep diabetes well controlled, because poor control can delay surgery, impair wound healing and complicate chemotherapy. Screen for cardiovascular disease in patients with cardiac risk factors or treatment known to affect the heart. Encourage regular physical activity during treatment to improve quality of life.
This is a narrative review rather than new evidence. Its value is as a checklist for the consultation where a patient on chemotherapy comes in about something else. In India, where oncology centres are often far from home, the local family physician is frequently the only doctor the patient sees between cycles.
- Ask what cancer treatment a patient is on and when the last cycle was, at every visit during treatment.
- Treat fever in a patient within weeks of chemotherapy as possible neutropenic sepsis until proven otherwise.
- Review glucose control before planned cancer surgery and during steroid-containing chemotherapy.
- Check blood pressure and cardiovascular risk in patients receiving treatments known to affect the heart.
- Encourage regular physical activity during treatment, adapted to how the patient feels.
Why it matters
The family physician is often the doctor a patient on chemotherapy sees first when something goes wrong.
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