Step 6 is concerned with managing recurrent or progressive disease.

The pathway and management of patients with recurrent or progressive CUP is a continuum of care and recapitulates Step 4.

With the low rates of curable CUP and the majority of patients palliated, it is likely that their current symptoms will worsen progressively, and this should be managed following discussion with palliative care specialists.

The supportive care needs of these patients are particularly important and should be reassessed. Palliative care referral and increased support within the community and GP involvement are also particularly important (Temel et al. 2017).