Chapter 81: Primary Care of the Patient With Cancer

As the oncology workforce faces increasing strain, primary care providers must develop competence in monitoring long-term treatment effects, managing persistent symptoms, and facilitating health promotion strategies tailored to survivors' evolving needs. The chapter conceptualizes cancer survivorship as a continuum beginning at diagnosis and extending throughout the patient's life, organized into three clinical phases that guide provider interventions. During the acute treatment phase, coordination between oncology and primary care ensures effective management of immediate side effects while maintaining routine preventive health services. The subsequent one to two years following treatment completion represent a transitional period where some acute toxicities resolve while others, including fatigue, chemotherapy-induced neuropathy, and mood disturbances, may persist or worsen. The late effects phase encompasses organ system complications that emerge years or decades after treatment completion, requiring systematic surveillance and early intervention. Primary care providers must maintain heightened awareness of treatment-related damage across multiple physiologic systems, particularly cardiovascular toxicity from anthracycline chemotherapy, endocrine dysfunction including thyroid and growth hormone insufficiency, medication-induced peripheral neuropathy affecting mobility and quality of life, and compromised bone health requiring aggressive preventive screening. The chapter emphasizes that survivors face substantially elevated risks for secondary malignancies and cancer recurrence, necessitating integration of biomarker surveillance into routine clinical assessment. Beyond medical management, primary care providers serve critical roles addressing psychosocial consequences including anxiety, depression, and pervasive recurrence fears affecting quality of life, along with economic hardships such as employment discrimination and insurance dependency. Health promotion represents a cornerstone of survivorship care, with evidence-based recommendations encompassing structured exercise programs, dietary modifications emphasizing plant-based foods, tobacco cessation support, and careful immunization strategies that exclude live vaccines during active treatment phases.