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      Primary care for cancers at diagnosis and follow-up: a narrative review

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          Abstract

          This paper is concerned about the family physician’s role in early cancer diagnosis and follow-up with his/hers patients who have just been diagnosed with cancer; treatment modalities for cancer; and family physician continuous roles for patients who are under definitive cancer treatment, experiencing side-effects of cancer treatment; some of the effective means to reduce these side-effects during cancer treatment and management of oncologic emergencies. Having some knowledge on the current cancer therapies would undoubtedly help family physicians to follow up patients with cancer more confidently, to appreciate their side-effects, symptomatic treatment, recognize the limit of primary care and be even useful for counseling and consultation with patients or their family members with a family history of cancer. Systematic searches with terms comprised “cancer”, “malignancy”, “primary care”, “general practice”, “cancer AND diagnosis” and “cancer AND follow-up” were done in the major databases such as Pubmed, ScienceDirect and Ovid. We employed selective searches with the above terms and their combination in some of the major journal such as The Lancet Oncology, The Lancet, New England Journal of Medicine, etc. These were followed by snowballing the relevant articles from the citation of references in those selected papers. The goal of this narrative review is not to provide exhaustive documentation of sound evidence for practice of primary care for cancer patients at diagnosis and follow-up. It mainly aims to provide specific evidence-based information and suggestions that are thought to be relevant for primary care professionals and policymakers.

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          Most cited references 53

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          Cancer diagnosis in primary care.

          Around a quarter of those in the developed world die of cancer. Most cancers present to primary care with symptoms, even when there is a screening test for the particular cancer. However, the symptoms of cancer are also symptoms of benign disease, and the GP has to judge whether cancer is a possible explanation. Very little research examined this process until relatively recently. This review paper examines the process of primary care diagnosis, especially the selection of patients for rapid investigation. It concentrates on the four commonest UK cancers: breast, lung, colon, and prostate as these have been the subject of most recent studies.
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            Five misconceptions in cancer diagnosis.

            Much investment has been put into facilities for early cancer diagnosis. It is difficult to know how successful this investment has been. New facilities for rapid investigation in the UK have not reduced mortality, and may cause delays in diagnosis of patients with low-risk, or atypical, symptoms. In part, the failure of new facilities to translate into mortality benefits can be explained by five misconceptions. These are described, along with suggested research and organisational remedies. The first misconception is that cancer is diagnosed in hospitals. Consequently, secondary care data have been used to drive primary care decisions. Second, GPs are thought to be poor at cancer diagnosis, yet the type of education on offer to improve this may not be what is needed. Third, symptomatic cancer diagnosis has been downgraded in importance with the introduction of screening, yet screening identifies only a small minority of cancers. Fourth, pressure is put on GPs to make referrals for those with an individual high risk of cancer - disenfranchising those with 'low-risk but not no-risk' symptoms. Finally, considerable nihilism exists about the value of early diagnosis, despite considerable observational evidence that earlier diagnosis of symptomatic cancer is beneficial.
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              Triphala, Ayurvedic formulation for treating and preventing cancer: a review.

              Triphala (Sanskrit tri = three and phala = fruits), composed of the three medicinal fruits Phyllanthus emblica L. or Emblica officinalis Gaertn., Terminalia chebula Retz., and Terminalia belerica Retz. is an important herbal preparation in the traditional Indian system of medicine, Ayurveda. Triphala is an antioxidant-rich herbal formulation and possesses diverse beneficial properties. It is a widely prescribed Ayurvedic drug and is used as a colon cleanser, digestive, diuretic, and laxative. Cancer is a major cause of death, and globally studies are being conducted to prevent cancer or to develop effective nontoxic therapeutic agents. Experimental studies in the past decade have shown that Triphala is useful in the prevention of cancer and that it also possesses antineoplastic, radioprotective and chemoprotective effects. This review for the first time summarizes these results, with emphasis on published observations. Furthermore, the possible mechanisms responsible for the beneficial effects and lacunas in the existing knowledge that need to be bridged are also discussed.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Family Medicine and Community Health & American Chinese Medical Education Association (USA )
                xxx-xxx
                2305-6983
                March 2013
                February 2014
                : 1
                : 1
                : 56-67
                Affiliations
                1Department of Family Medicine, Universiti Putra Malaysia, Malaysia
                2Klinik Kesihatan Simpang Kuala, Alor Setar, Kedah, Malaysia
                Author notes
                CORRESPONDING AUTHOR: Chew Boon How Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia chewboonhow@ 123456yahoo.com
                Article
                fmch20130109
                10.15212/FMCH.2013.0109
                Copyright © 2013 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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                Self URI (journal page): http://fmch-journal.org/
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                Review

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