Ietje Perfors

86 Chapter 4 Background Due to the ageing population and improvements in diagnosis and treatment, the number of cancer patients and cancer survivors is increasing. 1, 2 The WHO estimates a worldwide increase in cancer incidence, from 14.1 million new patients in 2012 to more than 20 million in 2025. 3 In addition, survival is improving in the Netherlands, there will be an estimated increase of 57% in cancer survivors in 2020. 4 In the near future, healthcare systems in several countries, such as The Netherlands, United Kingdom, Australia, USA and Canada, will face several challenges in fulfilling the needs and demands of this growing cancer patient population. 2, 5 In addition to the rising numbers of cancer patients, other changes concerning the cancer care path will challenge the healthcare system, such as the increased variety in treatment options, 2, 5 the increasing numbers of cancer patients with comorbidity resulting from aging 4, 6,7 of the population and the increased urge for patient involvement in decision making and self-management. 8, 9 Consequently, there is a need to create a personalised cancer care continuum for each patient, based on individual preferences, medical profile and best fitting treatment options. 6 Traditionally, management of cancer is delivered by in-hospital specialists. In countries where the general practitioner (GP) is the gatekeeper in the care system, such as the Netherlands, the GP has a long-lasting personal relation with the patient, is up to date with the patients’ medical history and preferences, and is considered as a trusted healthcare advisor by most patients. 10 These typical features of the GP provide opportunities for improving continuous and personalised care for the growing population of cancer patients. Therefore, patients, healthcare workers, governmental and professional organisations suggest a more prominent role of the GP in the guidance of patients during their cancer journey with a focus on empowerment, psychological and lifestyle support and follow-up care in the chronic disease stage. Even though a substantial role for primary care is advocated in the Netherlands and internationally, involvement of primary care in cancer care remains sporadic and unstructured. 4, 6, 7, 11