More efforts needed to reduce cancer mortality, report finds
■ Experts say primary care physicians should focus on proven interventions, such as smoking cessation, in guiding their patients toward a healthier way of life.
By Victoria Stagg Elliott — Posted April 25, 2005
Of the estimated 500,000 deaths expected from cancer this year, more than half are preventable, according to a March report issued by the American Cancer Society.
And experts say that primary care physicians play a key role in helping patients make necessary lifestyle changes and urging them to undergo screening tests. Stepping up these efforts could make a significant impact on this number.
"We have the tools to fight the disease, and primary care physicians are critical," said Vilma Cokkinides, PhD, MSPH, author of "Cancer Prevention and Early Detection Facts and Figures, 2005."
The report found that some factors, such as smoking rates, have improved, but still remain unacceptably high if the cancer society's goal of reducing by 50% the age-adjusted cancer mortality rates by 2015 is to be accomplished. Increases in obesity and overweight are also making this marker more difficult to achieve.
"We are making progress," said Richard C. Wender, MD, ACS first vice president. "But at midpoint, we are not where we should be."
Part of the reason is that significant barriers persist that undermine physicians' ability to successfully guide people toward needed lifestyle changes, experts say.
These experts advocate that doctors focus on proven interventions, such as promoting smoking cessation, in light of the fact that resources and time are limited.
American Medical Association policy encourages physicians to incorporate smoking cessation into their practices, and studies long have supported the idea that physician advice in this area can be effective.
Most recently, a study in Pediatrics suggested that a physician's influence might reach beyond the patient being treated. Researchers surveyed parents of pediatric patients who smoked and found that 50% would consider using medication to help them quit and 85% of that group would be amenable to a prescription from their child's doctor.
Authors suggest that this could be a way to reach a group of people who are more likely to see their child's doctor than their own.
Additionally, the researchers noted that helping a parent quit also would benefit the child's health over the long term.
"Young adults with children don't see their own primary care clinician very frequently, but they see their child's doctor," said Jonathan P. Winickoff, MD, MPH, lead author and assistant professor of pediatrics at Harvard Medical School.
"If you want to make sure the child grows up to be a nonsmoker, reduce the chance of sudden infant death syndrome, ensure the child has better nutrition and better shelter because the parent is not spending $1,800 a year on tobacco, this will make a huge difference in terms of the care for the child."
Colon cancer screening emphasized
In addition to lifestyle changes, the report also urges an increased use of screening tests, particularly for colon cancer. The AMA supports educational and public awareness programs that assure that doctors actively encourage patients to be screened for colon cancer and precursor lesions, and this subject is also part of a major ACS initiative.
A study in the March 28 Archives of Internal Medicine found ways to help physicians do this. Specifically, an intensive intervention customized to a practice's needs, which would include several educational visits from ACS staff, could improve screening rates for colorectal cancer among patients.
Experts said this study offered evidence that rates could be increased but noted there are challenges to bettering these numbers. Colorectal cancer screening tests are far from ideal and have limited appeal to patients.
"A lot of insurance companies don't pay for it, and we don't have the people or the equipment to do all the screening," said Thomas Norris, MD, professor in family medicine at the University of Washington School of Medicine in Seattle.
Additionally, while primary care physicians are key players in the efforts to prevent cancer from developing, doctors are not the only ones in the game, experts said. Schools, workplaces and government policy-makers all needed to be involved.
"There is no way we can do this alone," said Dr. Wender, who also chairs the Dept. of Family Medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia. "The environment plays an important role, and we need to make the right partnerships."