Clinical assessment of recurrent cancer: a Danish cohort study in general practice

GPs may detect cancer recurrence (CR) between specialised follow-up visits or after completed follow-up. Knowledge of CR detection is needed to inform GP decision making in general practice.

To examine how often GPs suspected cancer in patients presenting with CR, diagnostic actions taken, and how cancer suspicion and diagnostic actions were associated with the time to recurrence diagnosis.

A retrospective cohort study was conducted linking survey data and national register data.

Patients diagnosed with recurrence (of one of seven cancer types) between 1 January 2022 and 31 May 2024 were included. Their GPs provided details on the diagnostic process.

The GP survey response rate was 48% (1265/2611), and 469 patients presented with signs or symptoms of recurrence. The GPs suspected cancer at the first consultation in 226 patients (48%). A referral was made for diagnostic evaluation in 282 (60%) patients, with fast-track cancer pathways being the most frequent (48%) and fastest referral mode. Diagnostic intervals differed across cancer types at the 90th percentile. The longest intervals were seen for melanoma recurrence, which was 47 days longer than colorectal CR. The median diagnostic interval was 60 days shorter when GPs suspected cancer compared with no suspicion of cancer or other serious disease.

The GPs suspected cancer in approximately half of the patients and referred three in five presenting with signs or symptoms of recurrence. In approximately one-third, the GP had no suspicion. The length of the diagnostic interval differed considerably between the seven investigated cancer types.