Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis
<h4>Background</h4> <p>Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about investigation in primary care.</p> <h4>Aim</h4> <p>To summarise the available evidence on weight loss as a clinical feature of cancer in pat...
| Main Authors: | , , , , |
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| Format: | Journal article |
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Royal College of General Practitioners
2018
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| _version_ | 1826279505429266432 |
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| author | Nicholson, B Hamilton, W O'Sullivan, J Aveyard, P Hobbs, F |
| author_facet | Nicholson, B Hamilton, W O'Sullivan, J Aveyard, P Hobbs, F |
| author_sort | Nicholson, B |
| collection | OXFORD |
| description | <h4>Background</h4> <p>Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about investigation in primary care.</p> <h4>Aim</h4> <p>To summarise the available evidence on weight loss as a clinical feature of cancer in patients presenting to primary care.</p> <h4>Design</h4> <p>A diagnostic test accuracy review and meta-analysis.</p> <h4>Methods</h4> <p>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.</p> <h4>Results</h4> <p> 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.</p> <h4>Conclusion</h4> <p>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.</p> |
| first_indexed | 2024-03-06T23:59:44Z |
| format | Journal article |
| id | oxford-uuid:7580da56-d4f7-42b6-b513-1536c066ce06 |
| institution | University of Oxford |
| last_indexed | 2024-03-06T23:59:44Z |
| publishDate | 2018 |
| publisher | Royal College of General Practitioners |
| record_format | dspace |
| spelling | oxford-uuid:7580da56-d4f7-42b6-b513-1536c066ce062022-03-26T20:09:46ZWeight loss as a predictor of cancer in primary care: a systematic review and meta-analysisJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:7580da56-d4f7-42b6-b513-1536c066ce06Symplectic Elements at OxfordRoyal College of General Practitioners2018Nicholson, BHamilton, WO'Sullivan, JAveyard, PHobbs, F <h4>Background</h4> <p>Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about investigation in primary care.</p> <h4>Aim</h4> <p>To summarise the available evidence on weight loss as a clinical feature of cancer in patients presenting to primary care.</p> <h4>Design</h4> <p>A diagnostic test accuracy review and meta-analysis.</p> <h4>Methods</h4> <p>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.</p> <h4>Results</h4> <p> 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.</p> <h4>Conclusion</h4> <p>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.</p> |
| spellingShingle | Nicholson, B Hamilton, W O'Sullivan, J Aveyard, P Hobbs, F Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis |
| title | Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis |
| title_full | Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis |
| title_fullStr | Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis |
| title_full_unstemmed | Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis |
| title_short | Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis |
| title_sort | weight loss as a predictor of cancer in primary care a systematic review and meta analysis |
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