Operationalizing fear of cancer recurrence care: a modified Delphi study establishing a consensus-based clinical pathway for Danish cancer survivors

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.