Ietje Perfors

49 Background Cancer incidence and prevalence is increasing as a result of the ageing population combined with expanding diagnostic and treatment possibilities. Due to improved outcome following cancer treatment, the nature of cancer treatment is changing toward more chronic disease management. Health policy makers and healthcare professionals therefore call for a change in the way cancer care is provided, to focus on more integrated and personalised cancer care during and after treatment. 1, 2 In countries with gatekeeper healthcare systems, such as The Netherlands, general practitioners (GPs) are generally the coordinators of care, who have a longstanding and personal relationship with their patients. This enables knowledge of both the medical and personal situation of the patient and care, which is provided in a trusted environment with a familiar healthcare worker. Therefore, primary care is increasingly promoted as the preferred setting to provide integrated support during and after active cancer treatment, both to meet patient preference and to stabilise costs. 2, 3 The concept of shared care has been suggested as the way forward in the organisation of integrated cancer care. 2, 3 This shared care model is an organisational model involving both GPs and specialists in a formal, explicit manner. Shared care models enhance the optimal access of patients to both hospital care and community based supportive care along the entire cancer care continuum. 4 In shared care models, GPs, along with other primary care professionals, add their competence to balance the biomedical aspects of cancer care with the psychosocial context and preferences of the individual patient, 5 ensuring personalised, integrated care. To achieve shared care the GP should be involved in the organisation of care during cancer treatment. Traditionally, the role of primary care in palliative and end-of-life care is well established. 6 In addition, evidence suggests a solid role for primary care in cancer follow-up after treatment and survivorship care. 7–9 Less well appreciated, however, is primary care involvement during cancer treatment, particularly for patients treated with a curative intent. It is well established that in this phase patients frequently experience psychosocial distress and treatment-related side effects that negatively affect their quality of life. 10 Several studies suggest primary care involvement during active treatment, to 3