Purpose To systematically review existing literature on knowledge and confidence of primary care physicians (PCPs) in cancer survivorship care. Methods PubMed, Ovid MEDLINE, CINAHL, Embase, and PsycINFO were searched from inception to July 2022 for quantitative and qualitative studies. Two reviewers independently assessed studies for eligibility and quality. Outcomes were characterized by domains of quality cancer survivorship care. Results Thirty-three papers were included, representing 28 unique studies; 22 cross-sectional surveys, 8 qualitative, and 3 mixed-methods studies. Most studies were conducted in North America (n = 23) and Europe (n = 8). For surveys, sample sizes ranged between 29 and 1124 PCPs. Knowledge and confidence in management of physical (n = 19) and psychosocial effects (n = 12), and surveillance for recurrences (n = 14) were described most often. Generally, a greater proportion of PCPs reported confidence in managing psychosocial effects (24–47% of PCPs, n= 5 studies) than physical effects (10–37%, n = 8). PCPs generally thought they had the necessary knowledge to detect recurrences (62–78%, n = 5), but reported limited confidence to do so (6–40%, n = 5). There was a commonly perceived need for education on long-term and late physical effects (n = 6), and cancer surveillance guidelines (n = 9). Conclusions PCPs’ knowledge and confidence in cancer survivorship care varies across care domains. Suboptimal outcomes were identified in managing physical effects and recurrences after cancer. Implications for Cancer Survivors These results provide insights into the potential role of PCPs in cancer survivorship care, medical education, and development of targeted interventions.