Diagnostic pathways for lung cancer patients in Denmark: General practice events, first referral and stage at diagnosis

Background and purpose: This study examined lung cancer patients’ diagnostic pathways, focusing on first healthcare contact, general practice events, referral choice, and stage at diagnosis.
Patients and methods: General practices in three Danish regions participated in a retrospective survey of medical records for patients diagnosed with lung cancer between March 2019 and February 2021. General practitioners completed a questionnaire on initial contact, symptom presentation, diagnostic events and first referral. Socioeconomic data and tumor stage were retrieved from national registers. Associations between symptom presentation and diagnostic events were analysed.
Results: Among 1069 patients, 72% had initial contact in general practice, 22% at a hospital and 5% with out-of-hours care. Of patients starting in general practice (n = 766), 36% presented specific cancer symptoms, 48% non-specific symptoms, 9% both and 7% were asymptomatic. Diagnostic events included hesitation to seek care (10%), declining investigation or non-adherence (4%) and initial management for another disease (33%). Men were more likely to decline investigation or fail to follow-up (odds ratio [OR] 4.32; 95% confidence interval 1.75–10.65). Non-specific symptoms increased the odds of referral for another condition (OR 1.48) or another cancer type (OR 2.99). Most patients were first referred to imaging (48%), whereas 16% entered a cancer care pathway and 18% were acutely hospitalised. Advanced stage was common (80%) and more likely among acutely hospitalised patients (OR 2.68).
Interpretation: Most lung cancer patients present first in general practice. Non-specific symptoms are frequent and pose challenges for timely diagnosis.