Detecting cancer recurrence in general practice: a Danish national cohort study.

Abstract

GPs may detect cancer recurrences between specialised visits or after completed follow-up. There is limited evidence on diagnostic routes to detecting cancer recurrence. To examine the level of GP involvement in cancer recurrence detection and to assess the time from the index consultation in general practice to a cancer recurrence diagnosis (diagnostic interval). This was a retrospective cohort study linking survey data from 667 Danish general practices with national register data. Patients with a recurrence of seven cancer types diagnosed between 1 January 2022 and 31 May 2024 were included. The patients' GPs provided details on how the recurrence was detected. The GP survey achieved a response rate of 1265/2611 (48%). Of 1081 patients with recurrence, 478 (44%) first presented signs or symptoms of recurrence in general practice. Recurrence was diagnosed in 758 patients (70%) while they were under active specialised follow-up, and in 291 patients (27%) after completion of follow-up. Of 352 patients with a symptomatic presentation in general practice, the diagnostic pathway was initiated in general practice in 243 (69%), during subsequent follow-up in 57 (16%), and via other routes in 52 (15%). For patients with general practice-initiated diagnostic pathways, the 50th and 90th percentile of the diagnostic interval was 48 and 251 days for symptomatic presentations and 23 and 125 days for asymptomatic presentations, respectively. Four in 10 patients with cancer recurrence had their first point of contact in general practice. However, significant delays were observed. Improving detection pathways for cancer recurrence in general practice may benefit survivors across cancer types.