Johanne Dam Lyhne, Pernille Bech, Eva Rames Nissen, Christina Maar Andersen, Anne Katrine Hartmann Søby, Brigitta R Villumsen, Henriette Vind Thaysen, Laura Sandholdt Jensen, Iben Husted Nielsen, Thea Otto Mattsson, Anne Johansen, Emma Skov Rahbæk, Ulrike Johansen, Frederik Lynge Overgaard, Lise Ventzel, Lars Henrik Jensen, Matteo Allegretti, Eriseld Krasniqi, Allan 'Ben' Smith, Anders Bonde Jensen
This Delphi study provides a consensus-based clinical pathway for FCR, including systematic screening, needs-based assessment, and matched-care allocation. The findings address key implementation gaps in existing FCR guidelines and offer a structured framework for integrating FCR care into routine practice.
BACKGROUND AND PURPOSE: Fear of cancer recurrence (FCR) is a prevalent concern among cancer survivors. Although evidence-based FCR guidelines exist, their implementation requires further operationalization. This study aimed to establish expert consensus on a clinical pathway to operationalize guideline-concordant FCR care in Denmark. Patient/material and methods: A modified Delphi study was conducted, comprising Round 0 and three Delphi rounds. In Round 1, 112 experts were invited, and 80 participated (71%) in an online survey rating proposed pathway statements. Twenty-seven participants attended a consensus workshop (Round 2) to discuss and refine statements not reaching consensus in Round 1. In Round 3, 71 participants (63%) re-rated the revised statements from Round 2. Consensus was defined as ≥ 80% agreement.
RESULTS: Consensus was achieved for 10 statements in Round 1 and 6 revised or newly formulated statements in Round 3, including systematic screening of all cancer survivors with validated tools using a two-step approach, and initiation of screening at transition from treatment to follow-up. Consensus was achieved for need-based assessment guided by symptom severity and patient-expressed need. A matched-care model, aligning treatment intensity with FCR severity, achieved consensus in Round 1. Ongoing monitoring through re-screening during follow-up and post-intervention was endorsed. Timing of assessment and the management of FCR treatment non-response did not reach consensus.
INTERPRETATION: This Delphi study provides a consensus-based clinical pathway for FCR, including systematic screening, needs-based assessment, and matched-care allocation. The findings address key implementation gaps in existing FCR guidelines and offer a structured framework for integrating FCR care into routine practice.