Some Opinions on The Role of The Family Doctor in The Care of Cancer Patients- A Short Review

As the number of cancer patients has increased year by year with new methods of early diagnosis and screening, diagnosing an increasing number of patients, their care needs have also increased. We are also witnessing an increase in the survival of these patients obtained through the new therapeutic procedures Care for that growing number of cancer patients poses more and more problems to health systems and is often shared between primary and secondary care providers. Specialists in oncology are primarily responsible for the active treatment and management of cancer patients; however, after diagnostic the specific role of family physicians (FPS) is still not well defined despite that is constantly evolving.


Introduction
As the number of cancer patients has increased year by year with new methods of early diagnosis and screening, diagnosing an increasing number of patients, their care needs have also increased. We are also witnessing an increase in the survival of these patients obtained through the new therapeutic procedures Care for that growing number of cancer patients poses more and more problems to health systems and is often shared between primary and secondary care providers. Specialists in oncology are primarily responsible for the active treatment and management of cancer patients; however, after diagnostic the specific role of family physicians (FPS) is still not well defined despite that is constantly evolving.

The Conceptual Role of FPS in Cancer Patients' Care in Romania
In Romania, the role of the family doctor in the treatment and monitoring of cancer has not been precisely establisher. Thus, we have the point of view of palliative care specialists and the point of view of general practitioners (family doctors). In the latter case, we don't have a position paper of family doctors that provides for their involvement in cancer management. The point of view of palliation specialists is well outlined by several medical institutions, including "Casa Sperantei" which is the first center in Romania dedicated to hospice palliative care, with involvement in training doctors of various specialties in acquiring competence in palliative care. From the beginning, when palliative care was provided only to patients who were no longer receiving active antitumor treatment and to those in terminal condition, it was concluded that palliative care should be started in the early stages of the disease, right from diagnosis. Thus, the position of "Casa Sperantei" is that palliative care can go hand in hand with curative treatment. The benefits of early initiation of this type of care are primarily for the patient but also for the family and are mainly related to communication and acceptance of the diagnosis, knowledge of the disease and the changes it brings, awareness that symptoms can be treated, knowledge of social rights. The "Casa Sperantei" palliative care recommendations involve family physicians. Unfortunately, these recommendations are not applied in medical practice in Romania.
Cancer patients with non-complex needs will receive basic palliative care provided by: a) Family physicians trained in basic palliative care

ARTICLE INFO Summary
This short review seeks to draw attention to the growing care needs of cancer patients whose numbers are growing today due to new methods of early diagnosis and screening (and many other factors). For better care especially of patients living with this disease and by virtue of the principle of patient-centered medicine, the role of the family physician (FPS) in the oncology patient treatment team needs to be better defined. In this sense, we presented some approaches from several health systems, including the one in Romania. The conclusion is that FPS must be involved in the management of cancer patients, but there is no unanimity of opinion regarding the attributions that FPS may have in the team of diagnosis, treatment and follow-up of the cancer patient.

The Conception of The Role of FPS in Other Countries
Compared to this conception that ignores the existing tumor board, ESMO provides that patients in need of palliation be examined by a commission that will decide on therapeutic conduct.
This commission consists of medical oncologists, doctors who have competence in palliative care, an intensive care specialist, a surgeon, a radiotherapist, and any other specialist that the commission may convene for consultation [2]. In a the general practitioner is insufficient according to this study [7].
Coexistence of cancer with other chronic diseases an element that increases the complexity of the FPS intervention Comorbidities that generally affect cancer patients are another situation that a general practitioner encounters in practice. Because cancer affects the older population (over 60 years), cancer patients may have other morbidities that need to be treated. The general practitioner has to deal with the association of cancer with the pathology that the patient had before the diagnosis of cancer and this, with the challenges involved, has been studied by several researches. One of the researchers found that in the interval of two to five years from the diagnosis, the cancer patient goes to see his GP more often, even if he does not have other chronic diseases. What makes the care of cancer patients complex is that most of them have co morbidities. For this to happen, the oncologists should work with GPs' and develop methods to address cancer and create surveillance programs for cancer patients in order to meet their needs adequately [8].

Tools for The Practice Of FPS
Some authors try to define the usual tools for practice of GP.
In this respect Marianne Cuisinier and collaborators realized fal- of the results on the declared actual performance of general practitioners suggest that their cancer care needs to be improved [9].

The Role of The General Practitioner in Cancer Screening
General practitioners are quite often involved in the screening team for certain cancers that have been shown to be effective in screening. However, one aspect of the preventive activity carried out by general practitioners is related to establishing the risk factors that patients present. We support the assertion of the study conducted in Australia [9]. This study has shown that many patients who see a general practitioner have risk factors for cancer.
It is also found that only a small proportion of these patients had a preventive action from the family doctor. But considering that this study is from 1994, we believe that today things have changed. [10] Pain control and relief of symptoms are part of the responsibility of the general practitioner. Thanks to increasing survival rates and new methods of care, the role of GP is evolving and a constant restructuring of the management for cancer patients is required to provide them with proper care [11].

Conclusion
In this short review of the role of FPS in the trajectory of cancer