Cancer Updates GI and Breast Nashville: The Essential Role of Primary Care in Oncology Collaboration
Presenters:
Joseph Elsakr, MD, PhD; Matthew Beuter, MD, FACP
Conference:
Cancer Updates: GI and Breast, Nashville, TN
At the Cancer Updates GI and Breast Conference in Nashville, TN presented by Total Health, Dr Joseph Elsakr and Dr Matthew Beuter led conference attendees in a discussion about the growing role of primary care physicians (PCPs) in cancer care. With patients living longer due to improved cancer treatments, they emphasized that the need for ongoing collaboration between oncologists and PCPs has never been more critical.
Dr Beuter, a seasoned internal medicine physician with 29 years of experience, shared his perspective on how primary care has evolved in response to the increasing complexity of cancer care. Dr Elsakr, a newer physician just six months into his practice, provided insights into the challenges and opportunities facing a younger generation of PCPs.
The discussion centered on topics ranging from motivating patients for cancer screening, navigating patient reluctance and over-screening concerns, emerging cancer detection technologies, and the role of primary care in palliative care and survivorship.
Motivating Patients for Cancer Screening: A Long-Term Approach
The discussants noted one of the most significant contributions of PCPs to cancer prevention – ensuring that patients adhere to the recommended cancer screening guidelines. Both acknowledged that convincing reluctant patients to undergo necessary screenings, such as colonoscopies and mammograms, remains a challenge.
Dr Elsakr opened the discussion by asking Dr Beuter for advice on how to motivate patients who hesitate to get screened, particularly those who fear the discomfort or inconvenience of procedures like colonoscopy. In response, Dr Beuter emphasized the importance of long-term patient relationships. "The ability to look a patient in the eye and say, 'I've taken care of you for 20 years. I recommend you do this,' certainly helps." For patients who remain resistant, however, he has developed a direct but effective strategy: "I've told patients, 'I'll offer you a colonoscopy or chemotherapy. You tell me what you prefer.'" He explained that framing the conversation this way forces patients to weigh the minor inconvenience of screening against the far greater burden of cancer treatment.
Dr Elsakr, in turn, noted that he often revisits the screening discussion at multiple visits, even if a patient initially declines. He has found that persistence works, over time. "I’ve told my patients, ‘Okay, you don’t want to get this now, but I will bug you about it at future appointments.’" Dr Beuter agreed, saying that gentle persistence often leads to eventual compliance, with many patients later admitting they were glad they listened to their doctor’s advice.
Balancing Over-Screening Requests from Patients
The discussants further noted that, while some patients resist screening, others demand excessive testing – a growing challenge in the era of direct-to-consumer marketed diagnostic tests. Dr Elsakr noted that he has already encountered patients requesting things like whole-body MRI scans, thyroid ultrasounds, and other screenings that currently lie beyond the scope of evidence-based recommendations. He asked how Dr Beuter approaches these situations. Dr Beuter responded with a practical and cautionary approach, warning of the downside of excessive testing: "I give evidence-based advice, but sometimes stories are impactful. I tell patients about cases where someone self-referred for a whole-body CT scan, found a lung nodule, couldn’t stop thinking about it, insisted on a biopsy—and it turned out to be nothing, but they still went through unnecessary procedures and anxiety." His overall approach, he explained, is to guide patients based on scientific recommendations while also addressing the emotional component of their health concerns. Dr Elsakr agreed, adding that while shared decision-making is important, he firmly advises against non-evidence-based screening to protect patients from unnecessary stress and potentially harmful interventions.
Emerging Cancer Screening Technologies: The Promise and Challenges of Blood-Based Tests
The discussants also addressed the future of cancer detection, specifically, the development of multi-cancer early detection (MCED) blood-based tests, which purport to detect cancer at earlier stages than traditional methods. Dr Beuter acknowledged the growing importance of PCPs in navigating the promise and pitfalls of MCED, noting "This is the new frontier of cancer screening. But as primary care doctors, we’re going to be on the front lines of deciding when and how to use these tests." Dr Elsakr expressed excitement about MCED tests, particularly because they could help detect cancers for which no routine screening methodology currently exists. He also noted their potential to increase compliance among patients who refuse colonoscopies or mammograms: "Most patients are fine with getting their labs checked when they come in for a physical. If a simple blood test could screen for multiple cancers, we’d likely see a major increase in early detection." Both physicians, however, recognized the uncertainty surrounding these tests. Dr Beuter voiced concerns that patients might demand frequent MCED tests without fully understanding their limitations, leading to over-screening and unnecessary anxiety: "I worry this will prompt patients to come in all the time wanting tests we don’t yet fully understand how to use appropriately." Both discussants agreed that PCPs must be prepared to guide patients through the appropriate use of emerging cancer screening technologies while ensuring that traditional, well-validated screening methods should remain the priority.
Navigating Difficult Conversations: Delivering Uncertain or Bad News
One of the most challenging aspects of primary care which both physicians noted is delivering uncertain or bad news. Dr Elsakr asked Dr Beuter how he approaches the prospect of ambiguous test results, such as borderline PSA levels or a positive stool-based colon cancer test. Dr Beuter acknowledged the difficulty of these conversations, noting: "Giving bad news is tough, but at least it’s usually straightforward. What’s harder is delivering uncertain news—when we don’t yet know if something is significant." He explained that his strategy is to set expectations early, reassuring patients that further testing is needed, but avoiding unnecessary alarm: "I tell patients, ‘Let’s follow this up appropriately, but let’s not assume the worst until we have all the facts.’" Dr Beuter also emphasized the value of a long-term doctor-patient relationship in these conversations, adding: "It’s much easier to guide a patient through uncertainty if they already trust you."
The Role of Primary Care in Palliative Care and Hospice Discussions
The discussion concluded with an important and often overlooked topic – the role of PCPs in guiding patients through palliative care and hospice decisions. Dr Elsakr reflected on his experience in training, where most hospice discussions happened in acute hospital settings, often with little prior relationship with the patient. He noted that since beginning practice, he has had the opportunity to discuss hospice with patients he already knew, making these conversations more compassionate and patient centered. Dr Beuter agreed, stressing that PCPs are well-positioned to introduce hospice discussions in a way that normalizes and helps to de-stigmatizes it. "Patients sometimes feel that going into hospice means I’m giving up on them. But I frame it differently—I tell them hospice is about maximizing their quality of life…" He also highlighted the importance of coordinating with oncologists in these types of discussions: “Having a strong relationship with our oncology colleagues makes this process much smoother. If we’re all on the same page, the patient feels more supported." Dr Elsakr agreed, noting that good communication between primary care and oncology is essential in ensuring that patients receive the best possible care through all stages of a cancer journey.
Conclusion: A Stronger Partnership Between Primary Care and Oncology
The discussion between Dr Elsakr and Dr Beuter concluded their discussion by reinforcing the critical role that primary care physicians play in cancer prevention, treatment coordination, and survivorship care. By promoting screening, managing emerging technologies, navigating complex diagnoses, and supporting patients through palliative care, PCPs are essential partners in improving cancer outcomes. The key takeaway for attendees was that a strong partnership between PCPs and oncologists is vital—and ultimately benefits the patients who rely on both types of physicians for their long-term care.