Improving cancer care through primary care

We are both hugely fortunate to work as both general practitioners in North Wales and as researchers within the North Wales Centre for Primary Care Research, Bangor University, where we lead research projects to improve cancer care in North Wales. We work closely with doctors and nurses within the general practices and hospitals within Betsi Cadwaladr University Health Board on the programme of work called ‘Diagnose Quickly Follow Up Safely’. Our work is constantly inspired by our contact with patients the general practices where we work. All of our work is focused on influencing clinical practice or cancer policy.

We are often asked, by all sorts of people, why we get involved in cancer research as GPs. The answers are these:

Over 90% of people diagnosed with cancer will visit their GP with symptoms before diagnosis

GPs are closely involved in screening programmes for certain cancers
GPs are in a unique position of knowing their patients, and their family networks, very well, and are therefore able to help patients through their diagnosis and into treatment
GPs are experts at managing chronic conditions, and cancer is increasingly regarded as a chronic condition

Two examples illustrate the type of research we undertake:

The first is ‘Prostate Cancer – Re-design the follow-up system’. Prostate cancer is relatively common, although most men will live a very long time with, or after it. Men may have had surgery, radiotherapy, hormone treatment, or simply be monitored with blood tests (PSA). Whatever happens, prostate cancer patients have a high level of unmet needs for follow-up care. Hospital follow-up clinics are overstretched. Men are likely to be looked after by their GP teams once they are discharged; but GPs need more information, training, and team members to look after their varying problems well. Men also need a tailored protocol for long term PSA surveillance, which varies according to their type of disease and preceding treatment. The systems for doing this are not efficient at the moment; this could lead to errors. Therefore, this project aims to facilitate men to move towards primary care based follow-up. We are currently recruiting men to a randomised trial of a nurse intervention (needs assessment and detailed planning) compared with usual care, and developing an automated surveillance system for PSA testing.

The second is the ‘Early Lung Cancer Investigation and Diagnosis’ Trial. We are currently recruiting patients, at higher risk of lung cancer, who come to their GP with either a cough or breathlessness. If patients agree to take part they are either given an immediate chest X-ray, or receive ‘usual care’ which may mean a chest X-ray if their symptoms persist for three weeks or more. We are testing whether earlier investigations can diagnose lung cancer at a stage where it is more treatable.

We have other projects in progress or development, and always involve patients’ and consumers’ views in the design of other studies.

Richard Neal, Professor of Primary Care Medicine, Clare Wilkinson, Professor of General Practice, North Wales Centre for Primary Care Research, College of Health & behavioural Sciences, Bangor University.
This article appeared in the Western Mail University View column 13.2.14