medicina48巻13号

2011年12月発行

今月の主題 “がん診療”を内科医が担う時代 がん診療で期待される内科医の役割

家庭医が担うがん診療

著者： 岡田唯男¹

所属機関： ¹鉄蕉会 亀田ファミリークリニック館山

ページ範囲：P.2053 - P.2057

ポイント

★家庭医はその患者の背景や価値観を最も知る医師であり，リスクの見積，診断，ケアの調整，家族のケアなどを効果的に行うことができる．

★がんの診断が確定する前に告知の希望をたずねておくことは，家庭医のできる最も重要な連携の手段である．

★家庭医と専門医が行う協働には3つのパターンがある．ケアが途切れないためには，治療中も積極的にかかわる必要がある．

★がん専門医はできるだけ家庭医を巻き込むようにする．

参考文献

1）McWhinney IR, et al：Textbook of Family Medicine. Oxford Univ Press, New York, 2009

2）Tyler CV, et al：Cancer risk assessment；Examining the family physician's role. J Am Board Fam Med 19：468-477, 2006

3）Gramling R, et al：Family physician self-efficacy with screening for inherited cancer risk. Ann Fam Med 2：130-132, 2004

4）U. S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/recommendations.htm（最終アクセス2011.9）

5）科学的根拠に基づくがん検診推進のページ．http://canscreen.ncc.go.jp/index.html（最終アクセス2011.9）

6）Cardarelli R, et al：Having a personal health care provider and receipt of colorectal cancer testing. Ann Fam Med 7：5-10, 2009

7）Launoy G, et al：Screening for colorectal cancer；The role of the general practitioner. Am J Public Health 84：1963-1694, 1994

8）Potter MB, et al：Offering annual fecal occult blood tests at annual flu shot clinics increases colorectal cancer screening rates. Ann Fam Med 7：17-23, 2009

9）Jones R, et al：Alarm symptoms in early diagnosis of cancer in primary care；Cohort study using General Practice Research Database. BMJ 334：1040, 2007

10）Carney PA, et al：Discovery of breast cancers within 1 year of a normal screening mammogram；How are they found ? Ann Fam Med 4：512-518, 2006

11）Summerton N, et al：The general practitioner-patient consultation pattern as a tool for cancer diagnosis in general practice. Br J Gen Pract 53：50-52, 2003

12）Norman A, et al：Family physicians and cancer care；Palliative care patients' perspectives. Can Fam Physician 47：2009-2012, 2015-2016, 2001

13）Lundström LH, et al：Cross-sectorial cooperation and supportive care in general practice；Cancer patients' experiences. Fam Pract 28：532-540, 2011

14）Aubin M, et al：Family physician involvement in cancer care follow-up；The experience of a cohort of patients with lung cancer. Ann Fam Med 8：526-532, 2010

15）Hall SJ, et al：Toward shared care for people with cancer；Developing the model with patients and GPs. Fam Pract 28：554-564, 2011

16）Anvik T, et al://"When patients have cancer, they stop seeing me"；The role of the general practitioner in early follow-up of patients with cancer；A qualitative study. BMC Fam Pract 7：19, 2006

17）Jagsi R, et al：Long-term consequences of treatment on paid work after diagnosis of breast cancer. 2011 ASCO Annual Meeting. J Clin Oncol 29：（Suppl；Abstr 9007）, 2011

18）Wagner EH：Chronic disease management；What will it take to improve care for chronic illness? Eff Clin Pract 1：2-4, 1998

19）Grunfeld E, et al：Randomized trial of long-term follow-up for early-stage breast cancer；A comparison of family physician versus specialist care. J Clin Oncol 24：848-855, 2006

20）Khan NF, et al：Quality of care for chronic diseases in a British cohort of long-term cancer survivors. Ann Fam Med 8：418-424, 2010

21）Jiwa M, et al：Timely cancer diagnosis and management as a chronic condition；Opportunities for primary care. Med J Aust 189：78-82, 2008

22）Mitchell G, et al：General practitioner, specialist providers case conferences in palliative care；Lessons learned from 56 case conferences. Aust Fam Physician 34：389-392, 2005

23）Mitchell GK, et al：Do case conferences between general practitioners and specialist palliative care services improve quality of life? A randomised controlled trial. Palliat Med 22：904-912, 2008

24）Neergaard M, et al：Associations between home death and GP involvement in palliative cancer care. Br J Gen Pract 59：671-677, 2009

25）Seamark D, et al：Appropriate place of death for cancer patients；Views of general practitioners and hospital doctors. Br J Gen Pract 45：359-363, 1995

26）McDaniel SH, Campbell TL：Family-Oriented Primary Care. Springer, New York, 2004