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The RACGP Curriculum for Australian General Practice 2016

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Curriculum coverThe complete 2016 Curriculum consists of a number of units in addition to contextual units. All units will be available for download as a PDF shortly.

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Oncology

Definition

The general practice management of cancer involves caring for people with cancer and their carers over the entire spectrum of cancer control including:

  • primary prevention such as advising smoking cessation and providing other behavioural advice about diet, weight control, physical activity and sun protection
  • promoting and contributing to the delivery of national cancer screening programs for cervical, breast and colorectal cancer
  • early detection, investigation, referral and management of symptomatic cancer and appropriate management of symptoms of potential oncological significance
  • contributing to care during active treatment, in some cases through direct involvement in care delivery or in other instances through care coordination
  • psychological support of patients and families throughout the patient's cancer journey
  • early detection and management of recurrence of cancer or side effects of treatment including ongoing monitoring early following treatment and through remission
  • early detection and understanding for urgent management of cancer related emergencies such as neutropaenic sepsis, spinal cord compression, deep venous thrombosis and pulmonary emboli
  • palliation of symptoms associated with the disease and its treatment.

Curriculum in practice

Typical cases that illustrate how the oncology curriculum applies to general practice include:

  • A woman, 54 years of age, presents for a check up after her brother was diagnosed last week with bowel cancer. She says that an aunt had bowel cancer and that one of her grandfathers had died of the disease. She is now extremely worried about her risk of developing bowel cancer and is wondering what to do.
  • One of your receptionists asks if you can fit in her 32 year old brother, Andy, who has noticed a lump at the angle of his jaw. The lump is firm rather than rubbery and adds a darkish tint to the overlying skin. Andy is an otherwise fit and active father of two who has been a keen surfer all his life. Although sporting sun damaged skin, he has no obvious malignant lesions and cannot recall ever having had a lesion removed. Due to the suspicious nature of the lump, you refer Andy to a surgeon and the resultant pathology is of a secondary malignant melanoma without known primary. The area is excised more widely, leaving him with significant cosmetic deformity. A PET scan is arranged and reveals multiple further small lesions in soft tissue and bone. He enters a research trial that requires him to undergo a combination of chemotherapy and radiotherapy. After an initial improvement, his lesions progress and his care becomes palliative.

Rationale and general practice context

Cancer is responsible for around 30% of deaths in Australia,1 nearly 20% of the total burden of disease in Australia, as measured by death and disability.2

Malignant neoplasms account for 4.7 of every 100 general practice encounters, with skin cancers accounting for 1.1 of these encounters.3 The rate of general practice cancer related services is increasing.4

Skin cancers, including basal and squamous cell carcinomas and melanomas, are the most common cancers managed by general practitioners. The next most common cancers in Australia are prostate, female breast, colorectal and lung cancers.1

Excluding nonmelanocytic skin cancers, around 108 368 new cases of cancer (62 019 males and 46 349 females) were diagnosed in Australia in 2006.5 About 434 000 people are diagnosed with nonmelanocytic cancers each year.6

About two-thirds of the Australian population will develop at least one nonmelanocytic skin cancer in their lifetime6 and 1 in 3 men and 1 in 4 women will develop a major cancer before the age of 75 years.1 Cancer accounts for approximately 3 of every 10 deaths (29%) in Australia and although survival rates are improving, cancer accounts for nearly 40 000 deaths per year. In 2007, the risk of dying from cancer before the age of 75 years was 1 in 8 for males and 1 in 12 for females.5

While the number of deaths from cancer continues to rise, there is a decrease in the age standardised death rates in Australia.5 However, despite these improvements, cancer is now Australia's leading cause of death among 45–64 year olds and causes more premature deaths and overall disease burden than cardiovascular disease.1

General practitioners require a professional and patient centred approach to enable them to support patients across the spectrum of cancer prevention and management.

Related curriculum areas

Refer also to the curriculum statements:

Training Outcome of the five domains of general practice

1. Communication skills and the patient-doctor relationship

ONCT1.1

Use patient centred approaches to help develop strong relationships with patients and their families, to help provide support during the diagnosis and long term management of cancer.

ONCT1.2

Apply specific communication skills including the ability to:

  • break bad news sensitively
  • discuss and explain management issues from a patient centred perspective
  • discuss the patient-doctor relationship openly to restore any loss in confidence that may have occurred due to a diagnosis of cancer.
ONCT1.3

Identify and manage the psychosocial problems associated with a diagnosis of and the management of cancer.

ONCT1.4

Discuss cancer risk and approaches to reducing risk and initiating behavioural change.

ONCT1.5

Discuss the advantages and disadvantages of specific cancer screening tests and the interpretation of these tests.

ONCT1.6

Empower patients to ask their oncologist about issues that are important for them, such as prognosis and quality of life.

2. Applied professional knowledge and skills

ONCT2.1

Understand the assessment and minimisation of the lifestyle risk factors that contribute to cancer (ie. smoking, exposure to UV radiation, poor diet, insufficient physical activity and excessive alcohol consumption).

ONCT2.2

Identify individuals at increased risk of cancer due to familial, behavioural or environmental risk factors.

ONCT2.3

Assist patients to achieve lifestyle modifications (eg. quitting smoking) that will reduce their risk of cancer.

ONCT2.4

Demonstrate the ability to perform skin checks and manage suspicious skin lesions.

ONCT2.5

Obtain smoking and alcohol history and record this in the patient file.

ONCT2.6

Monitor and record body mass index and dietary history as part of a cancer risk assessment.

ONCT2.7

Understand the familial factors involved in increased risk of certain cancers.

ONCT2.8

Use a three-generation family history to identify patients who are at increased risk of cancer.

ONCT2.9

Be aware of National Health and Medical Research Council, Cancer Council and related evidence based guidelines on identifying those with an increased familial risk, and the role of surveillance programs, specific interventions and familial cancer clinics.

ONCT2.10

Identify evidence based programs for the early detection of cancer.

ONCT2.11

Be able to perform Pap tests with attention to quality assurance issues such as sterilisation of equipment and follow up of abnormal smears.

ONCT2.12

Understand the presentation, diagnosis and management of common cancers in general practice.

ONCT2.13

Demonstrate the ability to recognise significant symptoms that could be related to cancer and the appropriate pathways for investigation and referral of cancer.

ONCT2.14

Have a broad understanding of the principles of management of common cancers, including side effects of common treatments, potential interactions, and how to access specialised knowledge when needed.

ONCT2.15

Access information resources for patients to assist in their understanding of cancer and/or potential treatments.

ONCT2.16

Understand the potential psychosocial sequelae of cancer that affect people with cancer and their carers, management of such issues and available support services.

ONCT2.17

Identify those at risk and those with psychosocial problems.

ONCT2.18

Have an awareness of evidence based guidelines.

ONCT2.19

Obtain vital information from oncologists, such as prognosis, to help the patient regain control over management decisions that affect their quality of life.

ONCT2.20

Understand the reasons for treatment pathway choices and manage common side effects.

ONCT2.21

Have accurate and understandable information about cancer trials patients may wish to join.

ONCT2.22

Explore the lived experiences of cancer patients with empathy and validation.

3. Population health and the context of general practice

ONCT3.1

Broadly understand the epidemiology of common cancers in Australia, and particularly the role of risk factor modification and early detection of asymptomatic cancers; these are central to the role of general practice in reducing the impact of cancer in the community. This includes understanding:

  • that tobacco smoking is the leading cause of cancer, the range of cancers to which tobacco contributes and options to facilitate quitting
  • the relationship between ultraviolet radiation exposure and skin cancers
  • the evidence supporting the role of increased fruit and vegetables in the diet, increased physical activity, maintainance of a healthy body weight, and limiting or avoidance of alcohol in reducing the risk of certain cancers
  • the biological risk factors for cancer, including viruses such as hepatitis B and human papilloma virus (HPV)
  • the current evidence based guidelines in the primary care setting relating to healthy diet, physical activity and alcohol intake, including being able to assist patients to adopt preventive lifestyle behaviours.
ONCT3.2

Have a broad understanding of cancer screening principles.

ONCT3.3

Understand the evidence relating to screening tests for cervical, breast and colorectal cancer, including their pros and cons, appropriate use and follow up of abnormal screening tests.

ONCT3.4

Understand the role of GPs in national screening programs (eg. BreastScreen and the National Bowel Cancer Screening Program), including the significance and management of a positive faecal occult blood test.

ONCT3.5

Be aware of the complex issues surrounding testing for the early detection of prostate cancer and of the guidelines of organisations such as the Cancer Council Australia and the RACGP.

ONCT3.6

Be able to describe the various community and consumer resources available for patients and their families affected by cancer.

4. Professional and ethical role

ONCT4.1

Be able and prepared to act as a patient advocate when appropriate.

ONCT4.2

Recognise the importance of patient autonomy and respecting patients' choices when making complex treatment and management decisions, which may include the decision to decline treatment.

ONCT4.3

Support the patient's carers while maintaining the patient's right to confidentiality.

ONCT4.4

Recognise the ethical issues associated with early detection of asymptomatic cancer.

ONCT4.5

Liaise effectively with oncologists.

ONCT4.6

Work professionally within a multidisciplinary team.

ONCT4.7

Utilise evidence based guidelines to assist in the care of patients.

5. Organisational and legal dimensions

ONCT5.1

Be aware of, and be able to access, relevant clinical guidelines for the prevention, early detection and treatment of cancer.

ONCT5.2

Be aware of information sources for patients and carers.

ONCT5.3

Maintain adequate clinical records and ensure appropriate follow up of significant symptoms that could be related to cancer.

ONCT5.4

Be able to identify people at risk of cancer and utilise practice information systems (electronic and paper) to facilitate appropriate screening and surveillance.

ONCT5.5

Be familiar with the legal implications of power of attorney and advanced treatment directives.

ONCT5.6

Be aware of appropriate referral pathways for people with cancer within the local network.

ONCT5.7

Be aware of local support services for people with cancer and their carers.

ONCT5.8

Recognise the importance of care coordination and the need to act in a coordinating role if this is appropriate and desired by the patient and care team.

ONCT5.9

Organise effective practice management systems to support the multidisciplinary team in managing cancer.

Learning objectives across the GP professional life

Medical student

1. Communication skills and patient-doctor relationship

ONCLM1.1

Describe the use of patient centred approaches to breaking bad news.

ONCLM1.2

Describe the use of patient centred approaches to communicating cancer risk information and promoting healthy behaviours.

2. Applied professional knowledge and skills

ONCLM2.1

Be able to perform a basic history and examination to assess symptoms associated with cancer.

ONCLM2.2

Describe the usual presentations of common cancers.

3. Population health and the context of general practice

ONCLM3.1

Describe the different national cancer screening programs.

ONCLM3.2

Be able to conduct basic assessment of environmental, lifestyle and familial cancer risks.

4. Professional and ethical role

ONCLM4.1

Outline the role of the GP within a multidisciplinary team that cares for people with cancer.

ONCLM4.2

Outline the role of the GP as a patient advocate.

5. Organisational and legal dimensions

ONCLM5.1

Outline the role of the GP in delivering cancer screening programs within the health system.

ONCLM5.2

Describe the importance of maintaining adequate clinical records and follow up of patients with symptoms that could be related to cancer.

Prevocational doctor

1. Communication skills and patient-doctor relationship

ONCLP1.1

Recognise the psychological impact of a cancer diagnosis on patients and their families and demonstrate approaches to breaking bad news.

2. Applied professional knowledge and skills

ONCLP2.1

Conduct a detailed assessment of cancer risk and provide basic advice on behaviour change to reduce risk.

ONCLP2.2

Demonstrate knowledge of the presentation, diagnosis and management of common cancers in general practice.

ONCLP2.3

Have a basic understanding of the management of common cancers and side effects.

ONCLP2.4

Demonstrate appropriate investigation of symptoms associated with cancer.

3. Population health and the context of general practice

ONCLP3.1

Implement national cancer screening programs in the hospital situation and be competent in conducting investigations (eg. a Pap test) as part of cancer screening.

4. Professional and ethical role

ONCLP4.1

Describe the importance of patient autonomy and respect for patient choices when involved in complex decisions about their healthcare.

ONCLP4.2

Demonstrate how to work professionally within a multidisciplinary team.

5. Organisational and legal dimensions

ONCLP5.1

Outline appropriate referral pathways for people with cancer.

ONCLP5.2

Outline the importance of local support services for people with cancer and their carers.

Vocational registrar

1. Communication skills and patient-doctor relationship

ONCLV1.1

Demonstrate the ability to apply patient centred communication skills to support behaviour change to reduce cancer risk.

ONCLV1.2

Demonstrate how to discuss different cancer screening tests and programs to support patients' informed choices.

ONCLV1.3

Demonstrate an ability to discuss the importance of general practice care during and after active treatment of cancer.

ONCLV1.4

Demonstrate the ability to communicate with patients and their families/carers about management, informed decisions and emotional issues.

2. Applied professional knowledge and skills

ONCLV2.1

Describe the management of common cancers and the recognition and management of side effects of treatment.

ONCLV2.2

Demonstrate how to apply patient centred care to manage the complex psychosocial issues of patients and families affected by a diagnosis of cancer.

ONCLV2.3

Recognise and apply evidence based management for the assessment of symptoms associated with cancer.

3. Population health and the context of general practice

ONCLV3.1

Demonstrate awareness of national cancer screening programs.

ONCLV3.2

Describe the advantages and disadvantages of different cancer screening tests available in Australia.

ONCLV3.3

Discuss the use of relevant clinical guidelines for the prevention, early detection and care of cancer.

4. Professional and ethical role

ONCLV4.1

Describe the ethical issues associated with early detection of asymptomatic cancer.

ONCLV4.2

Demonstrate use of evidence based guidelines to assist in the care of patients with cancer or those with symptoms related to cancer.

ONCLV4.3

Describe the role of the GP as patient advocate for people with cancer and their carers.

5. Organisational and legal dimensions

ONCLV5.1

Describe appropriate referral pathways for people with cancer or symptoms related to cancer.

ONCLV5.2

Outline information sources for patients with cancer and their carers.

ONCLV5.3

Describe the use of practice information systems to facilitate cancer screening and surveillance.

Continuing professional development

1. Communication skills and patient-doctor relationship

ONCLC1.1

Demonstrate regular updating of communication skills in cancer related areas.

ONCLC1.2

Describe approaches to empowering patients to ask their oncologists questions about their cancer care.

2. Applied professional knowledge and skills

ONCLC2.1

Be able to identify gaps in knowledge, skills and attitudes in relation to evidence based cancer care and prevention.

ONCLC2.2

Demonstrate keeping up-to-date with managing the side effects of treatment and cancer emergencies.

3. Population health and the context of general practice

ONCLC3.1

Undertake to access ongoing professional development in relation to your identified knowledge gaps in cancer care and prevention.

ONCLC3.2

Undertake to regularly update your knowledge and skill base in the light of any new and emerging evidence in cancer care and prevention.

4. Professional and ethical role

ONCLC4.1

Demonstrate the role of patient advocate.

ONCLC4.2

Demonstrate support for patients to make informed decisions about cancer screening and treatment.

5. Organisational and legal dimensions

ONCLC5.1

Demonstrate incorporation of evidence based guidelines for the prevention, early detection and care of cancer within practice systems.

ONCLC5.2

Maintain adequate clinical records and ensure appropriate follow up of significant symptoms that could be related to cancer.

ONCLC5.3

Demonstrate the ability to identify people at risk of cancer and utilise practice information systems to facilitate appropriate screening and surveillance, including recall systems.

ONCLC5.4

Use local support services to improve the care of people with cancer and their carers.

References

  1. Australian Institute of Health and Welfare. Australia's health 2010. Canberra: Australian Institute of Health and Welfare; 2010.
  2. Begg SJ, Vos T, Barker B, Stanley L, Lopez AD. Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. Med J Aust 2008;188:36-40.
  3. Britt H, Charles J, Henderson J, et al. General practice activity in Australia 2009–10. Canberra: Australian Institute of Health and Welfare; 2010.
  4. Britt H, Charles J, Henderson J, et al. General practice activity in Australia 2000–01 to 2009–10: 10 year data tables. Canberra: Australian Institute of Health and Welfare; 2010.
  5. Australian Institute of Health and Welfare and Australian Association of Cancer Registries. Cancer in Australia: an overview, 2010. Canberra: Australian Institute of Health and Welfare; 2010.
  6. Australian Institute of Health and Welfare and Cancer Australia. Non-melanoma skin cancer: general practice consultations, hospitalisation and mortality. Canberra: Australian Institute of Health and Welfare & Cancer Australia; 2008.

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