Risk of cancer and serious disease in Danish patients with urgent referral for serious non-specific symptoms and signs of cancer in Funen 2014-2021

Abstract

Background: In 2011, as the first European country, Denmark introduced the non-organ-specific cancer patient pathway (CPP) for patients presenting with non-specific symptoms and signs of cancer (NSSC). The proportion of patients with cancer over time is unknown.

Methods: A retrospective cohort study of all patients with a NSSC-CPP investigational course in the province of Funen to the Diagnostic Centre in Svendborg from 2014 to 2021 was performed to evaluate the proportion of patients with cancer and serious disease over time.

Results: A total of 6698 patients were referred to the NSSC-CPP of which 20.2% had cancer. While the crude referral rate increased from 114 per 100,000 people in 2014 and stabilised to around 214 in 2017-2021, the cancer detection rate of the total yearly new cancers in Funen diagnosed through the NSSC-CPP in DC Svendborg increased from 3 to 6%.

Conclusions: With now high and stable conversion and crude referral rates, the NSSC-CPP is one of the largest CPPs in Denmark as measured by the number of new cancer cases found. Similar urgent referral programmes in other countries might fill an unmet medical need for patients presenting with serious non-specific symptoms and signs of cancer in general practice.

Fig. 1. Sunburst plot of the diagnosis distribution of malignant disease, serious non-malignant disease, and non-serious disease/finding.

For serious non-malignant disease, the group “Other” compromises a number of rare conditions with a less than 1% prevalence, including arthritis (0.7%), chronic obstructive pulmonary disease (0.7%), benign tumours (0.5%), and more. For non-serious disease/finding, the group “Other” includes a number of conditions with a less than 1% prevalence including goitre (0.9%), unexplained fever (0.6%), irritable bowel syndrome (0.6%), abdominal hernia (0.6%), and more. MDS/PV myelodysplastic syndrome/polycythaemia vera, PMR/GCA polymyalgia rheumatica/giant cell arteritis, GI ulcer gastrointestinal ulcer, MGUS monoclonal gammopathy of undetermined significance.

Fig. 2. Violin plots displaying the age distribution of different cancer types diagnosed within 6 months from NSSC-referral to the Diagnostic Centre, Svendborg, from 2014 to 2021.

The category “Other” embraces CUP or unknown (61 patients), head and neck cancers (15), sarcomas (12), thyroid cancers (6), brain cancers (6), vulva cancers (<5), testicular cancers (<5), and adrenal cancers (<5). CUP cancer of unknown primary, HCC hepatocellular carcinoma, MDS/PV myelodysplastic syndrome/polycythaemia vera, upper GI upper gastrointestinal tract which includes the oesophagus, gastroesophageal junction, stomach, and small intestine.