The role of General Practitioners in Cancer Control. An underexploited resource in translational oncology

Pier Giorgio Natali MD PhD The Italian League for the Fight Against Cancer (www.LILT.it) Mediterranean Taskforce for Cancer Control (www.mtcc-prevention.net)

Introduction : Because of increasing life expectancy, cancer represents a global emergency that can be tackled only by policies aimed at ensuring to the largest population a continuum of primary prevention interventions, access to early diagnosis and therapies. Description: A large fraction of cancers are already avoidable by primary prevention, the remaining averted by early diagnosis, thus limiting the occurrence of advanced disease “the key challange in cancer treatment”. Results: The presence of general practitioners (GPs) on the territory has steadily declined in many public and private mixed health systems due to policies that have moved health care from the territory to the hospital. This is in contrast to long standing recognition of the link between life expectancy and density of family doctors. The limits of this "hospital-focussed" architecture are now dramatically underscored by the occurring Covid pandemic. Collectively, the negative effects of this organizational drift require interventions that cannot be further postponed. Thus any political inertia not fully exploiting the available knowledge is unjustified on medical, ethical and social points of view and is necessarily fostering an increase in unsustainable costs even for wealthy societies. In this context, GPs can play a major role in cancer control because a) can provide reliable censored information, thus contributing to increase health literacy b) know the patient's history, living- occupational enviroment, thus being able to perceive symptoms that patient may underestimate c) can enforce preventive and diagnostic procedures tailored on patient’s co-morbidities d) cure chronic diseases often heralding tumor onset e) ensure referring specialists according to criteria of priority and congruity . Take home message: On the whole, family medicine is therefore a privileged reference for health policy makers being the source of information on the feasibility, effectiveness and economic sustainability of the adopted policies also in view of the increasing disparities. GPs are an essential partners and the ultimate verifier of translational medicine in cancer management including close care of the survivors