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Weight loss highly predictive of cancer in primary care settings


Weight loss highly predictive of cancer in primary care settings

Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about the investigation in primary care. Therefore it poses a diagnostic challenge to clinicians in non-specialist settings such as primary care.Brian D Nicholson at Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford and colleagues conducted a diagnostic test accuracy review and meta-analysis to summarise the available evidence on weight loss as a clinical feature of cancer in patients presenting to primary care.The researchers concluded that weight loss is highly predictive of cancer in primary care settings.

The researchers sorted out 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) and included them in analysis. 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.

The investigators included a total of 25 studies 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.

It was concluded that 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.

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Anjali Nimesh

Anjali Nimesh

Anjali Nimesh Joined Medical Dialogue as Reporter in 2016. she covers all the medical specialty news in different medical categories. She also covers the Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in medical filed. She is a graduate from Dr. Bhimrao Ambedkar University. She can be contacted at editorial@medicaldialogues.in Contact no. 011-43720751
Source: with inputs from BJGP

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