Brian D Nicholson 1 , William Hamilton 2 , Jack O'Sullivan 1 , Paul Aveyard 1 , Fd Richard Hobbs 1 Show Affiliations »
Abstract
BACKGROUND: Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about investigation in primary care. AIM: To summarise the available evidence on weight loss as a clinical feature of cancer in patients presenting to primary care. DESIGN AND SETTING: A diagnostic test accuracy review and meta-analysis. METHOD: Studies reporting 2 × 2 diagnostic accuracy data for weight loss (index test) in adults presenting to primary care and a subsequent diagnosis of cancer (reference standard) were included. QUADAS-2 was used to assess study quality. Sensitivity, specificity, positive likelihood ratios, and positive predictive values were calculated, and a bivariate meta-analysis performed. RESULTS: A total of 25 studies were included, with 23 (92%) using primary care records. Of these, 20 (80%) defined weight loss as a physician's coding of the symptom; the remainder collected data directly. One defined unexplained weight loss using objective measurements. Positive associations between weight loss and cancer were found for 10 cancer sites: prostate, colorectal, lung, gastro-oesophageal, pancreatic, non-Hodgkin's lymphoma, ovarian, myeloma, renal tract, and biliary tree. Sensitivity ranged from 2% to 47%, and specificity from 92% to 99%, across cancer sites. The positive predictive value for cancer in male and female patients with weight loss for all age groups ≥60 years exceeded the 3% risk threshold that current UK guidance proposes for further investigation. CONCLUSION: A primary care clinician's decision to code for weight loss is highly predictive of cancer. For such patients, urgent referral pathways are justified to investigate for cancer across multiple sites. © British Journal of General Practice 2018.
BACKGROUND: Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about investigation in primary care. AIM: To summarise the available evidence on weight loss as a clinical feature of cancer in patients presenting to primary care. DESIGN AND SETTING: A diagnostic test accuracy review and meta-analysis. METHOD: Studies reporting 2 × 2 diagnostic accuracy data for weight loss (index test) in adults presenting to primary care and a subsequent diagnosis of cancer (reference standard) were included. QUADAS-2 was used to assess study quality. Sensitivity, specificity, positive likelihood ratios, and positive predictive values were calculated, and a bivariate meta-analysis performed. RESULTS: A total of 25 studies were included, with 23 (92%) using primary care records. Of these, 20 (80%) defined weight loss as a physician's coding of the symptom; the remainder collected data directly. One defined unexplained weight loss using objective measurements. Positive associations between weight loss and cancer were found for 10 cancer sites: prostate, colorectal , lung, gastro-oesophageal , pancreatic , non-Hodgkin's lymphoma , ovarian, myeloma , renal tract, and biliary tree. Sensitivity ranged from 2% to 47%, and specificity from 92% to 99%, across cancer sites. The positive predictive value for cancer in male and female patients with weight loss for all age groups ≥60 years exceeded the 3% risk threshold that current UK guidance proposes for further investigation. CONCLUSION: A primary care clinician's decision to code for weight loss is highly predictive of cancer . For such patients , urgent referral pathways are justified to investigate for cancer across multiple sites. © British Journal of General Practice 2018.
Entities: Disease
Species
Keywords:
cancer; diagnosis; primary care; systematic review; weight loss
Mesh： See more »
Year: 2018
PMID： 29632004 PMCID： PMC5916078 DOI： 10.3399/bjgp18X695801
Source DB: PubMed Journal: Br J Gen Pract ISSN： 0960-1643 Impact factor: 5.386