A differentiated approach to referrals from general practice to support early cancer diagnosis - the Danish three-legged strategy

Abstract

When aiming to provide more expedited cancer diagnosis and treatment of cancer at an earlier stage, it is important to take into account the symptom epidemiology throughout the pathway, from first bodily sensation until the start of cancer treatment. This has implications for how primary-care providers interpret the presentation and decisions around patient management and investigation. Symptom epidemiology has consequences for how the health-care system might best be organised. This paper argues for and describes the organisation of the Danish three-legged strategy in diagnosing cancer, which includes urgent referral pathways for symptoms suspicious of a specific cancer, urgent referral to diagnostic centres when we need quick and profound evaluation of patients with nonspecific, serious symptoms and finally easy and fast access to 'No-Yes-Clinics' for cancer investigations for those patients with common symptoms in whom the diagnosis of cancer should not be missed. The organisation of the health-care system must reflect the reality of symptoms presented in primary care. The organisational change is evaluated and monitored with a comprehensive research agenda, data infrastructure and education.

Figure 1

The diagnostic funnel showing the symptom epidemiology from public to cancer diagnosis. General practice is placed between the public ‘symptom pool' and the decision to investigate for cancer.

Figure 2

The symptom continuum in general practice. A symptom can present clinically in many ways.

Figure 3

The structure of the Danish three-legged diagnostic strategy.