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GPs central to boosting cancer screening participation


Anastasia Tsirtsakis


11/09/2020 4:11:03 PM

But Dr Lara Roeske, a cervical cancer screening expert, says there needs to be a ‘whole of practice approach’.

GP speaking to a patient
Reporting for the five most common cancers have reduced by about a third in Victoria during the pandemic.

Cancer is a leading cause of death in Australia, with one in two people diagnosed with cancer by the age of 85.
 
Australia’s three cancer screening programs – BreastScreen Australia, the National Cervical Screening Program (NCSP) and the National Bowel Cancer Screening Program (NBCSP) – have helped to ensure earlier diagnosis and treatment, and Dr Lara Roeske says GPs have been central to that effort.
 
‘Australian research has demonstrated the power that the GP has in this particular role, and in fact, GPs are arguably the most effective intervention when it comes to increasing participation,’ she told newsGP.
 
Dr Roeske, a GP and cervical cancer screening expert, says this is particularly evident with the NCSP. Carried out and overseen in general practice, since its implementation in 1991 incidence and mortality rates due to cervical cancer in Australia have halved.  
 
‘Australia is known as a world leader in terms of cervical cancer prevention,’ Dr Roeske said.
 
‘The GP has been at the heart of the program because up until now, where we do have the option of self-collection – and even that still needs to be supervised by GP – the taking of the sample occurs in general practice.
 
‘That’s been incredibly helpful in terms of participation.’
 
However, with less than six out of 10 eligible women participating regularly in the NCSP, Dr Roeske says there is ‘room for improvement’.
 
This is also the case for other programs. In 2016–2017, just 55% of the target age group participated in BreastScreen Australia, and only 41% of the 4.1 million people invited to partake in the NBCSP were tested.
 
Meanwhile, concerns over low participation rates have grown since the onset of the coronavirus pandemic, with people delaying seeking medical advice expected to lead to an increase in cancer diagnoses over the next 12 months and more patients presenting with later-stage incurable disease.
 
During a joint press conference on Friday 11 September, Premier Daniel Andrews and Victorian Health Minister Jenny Mikakos flagged that there had been a noticeable reduction in screening, diagnosis and early treatment for cancers.
 
Reporting for the five most common cancers – colorectal, prostate, breast, melanoma and lung – have reduced by about a third, with an even greater reduction in reports for head and neck cancer.
 
Similarly in April, cervical cancer screening rates fell by 67% with a slight improvement in May, but presentations were still down by 49% compared to pre-COVID data.
 
To help boost participation in the NBCSP, Dr Roeske says it would be beneficial to have kits readily available in practice.
 
‘There is a lot of dissatisfaction among GPs about really the divorcing of the test from the GP,’ she said.
 
‘There’s still a lot of good that GPs can do there, but I’m sure many of us would really feel heartened if we were able to hand over that kit at the time we were endorsing it.
 
‘There’s been some research done where that’s happening in Aboriginal and Torres Strait Islander communities in Australia – because of course, Aboriginal Torres Strait Islanders have much lower participation rates across all screening programs, and as a result, have higher mortality and higher incidence than non-Indigenous Australians.
 
‘That research has shown very promising results around the uptake when the kits are actually in practice settings.’
 
To help boost participation, Dr Roeske advises GPs to start assessing a patient’s eligibility from the moment they walk through the door.
 
She recommends taking a thorough family history of note, a personal history of symptoms, consider any genetic testing results, and to look into whether the patient is already a part of a screening program but may be a lapsed screener.
 
‘That information gathering is really to help clinical decision making about “Is this patient actually eligible for screening? Or should they actually be on a diagnostic pathway?”,’ Dr Roeske said.
 
Depending on the nature of a consultation, she acknowledges that time may not always permit an in-depth conversation about screening, but said that GPs should not underestimate their ability to at least plant the seed. 
 
‘It’s a very dynamic environment the consultation, and I think what we probably just need to do is take a breath and not try to solve all problems in the one consultation,’ Dr Roeske said.
 
‘[You could] raise the topic of screening at a consultation that’s a busy one and say “Look, I’d really like to talk to you more about these screening programs, and why it would be a really good idea”, and just check back with patients to see if they’re receptive to that information.

Lara-Roeske-Article.jpg
Dr Lara Roeske says GPs are arguably the most effective intervention when it comes to increasing patient participation in cancer screening programs.
 
‘I would like to really assure GPs that just a few positive words can set patients off in the right direction.
 
‘For some patients there are all sorts of reasons why they don’t want to participate or don’t make the time for themselves. But it’s not something that GPs need to feel they need to solve at that time, and that there is an opportunity to follow up with subsequent consultations.’
 
But it is not GPs alone who have a role to play. She says a ‘whole of practice approach’ is also important.
 
‘GPs are at the heart and centre of the primary care team [but] it’s really how the whole practice functions around supporting screening, and that can start at the front,’ Dr Roeske said.
 
‘It’s incredibly important to ensure patients have up-to-date contact details and information around whether they identify as Aboriginal and/or Torres Strait Islander.
 
‘Practice nurses can also be incredibly effective at talking to patients about preventive health and what might be available to them. So a whole of practice approach, leveraging on the strength of the primary care team is really important, with a GP at the centre providing clinical oversight.’
 
Dr Roeske also notes that once an individual is participating in a screening program that GPs also play an important role in following up with patients, and ensuring they continue to do so.
 
‘This is really incredibly important around screening where there is a negative result,’ she said.
 
‘There is an appropriate period of time after which the patient would return to screen if they’re negative, and the follow up of abnormal screening is incredibly important results.
 
‘This is where GPs are key both in encouraging and reminding patients to follow up, interpreting the significance of these results, and there’s also a key role to play when exiting a program. So when is it safe to exit? How should patients exit? And supporting those conversations.’
 
To better understand how the primary healthcare workforce engages with the national cancer screening programs, the Department of Health is funding a study led by the University of Melbourne, RACGP, Australian Association of Practice Management, Australian Primary Health Care Nurses Association and the VCS Foundation.
 
Findings will lead to the development of materials and initiatives to assist in boosting participation, education and engagement.
 
‘[As GPs], we work in so many areas where there’s [a lack of] evidence and so many unknowns, but this is one area where GPs don’t need to worry or think too hard,’ Dr Roeske said.
 
‘The three national screening programs are so well supported by evidence in terms of benefits that they should have no doubt, and continue to be as they are – simply, one of the strongest advocates for screening for their patients.’
 
To find out more about participating in the study, email or call Research Assistant Ebony Verbunt: ebony.verbunt@unimelb.edu.au, 0429 928 039.
 
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