Abstract
BackgroundWe aimed to understand the time period of cancer diagnosis and the cancer types detected in primary care patients with unexpected weight loss (UWL) to inform cancer guidelines.MethodsThis retrospective matched cohort study used cancer registry linked electronic health records from the UK’s Clinical Practice Research Datalink from between 2000 and 2014. Univariable and multivariable time-to-event analyses examined the association between UWL, and all cancers combined, cancer site and stage.ResultsIn all, 63,973 patients had UWL recorded, of whom 1375 (2.2%) were diagnosed with cancer within 2 years (days-to-diagnosis: mean 181; median 80). Men with UWL (HR 3.28 (2.88–3.73)) and women (1.87 (1.68–2.08)) were more likely than comparators to be diagnosed with cancer within 3 months. The association was greatest in men aged ≥50 years and women ≥70 years. The commonest cancers were pancreas, cancer of unknown primary, gastro-oesophageal, lymphoma, hepatobiliary, lung, bowel and renal-tract. The majority were late-stage, but there was some evidence of association with stage II and stage III cancers. In the 3–24 months after presenting with UWL, cancer diagnosis was less likely than in comparators.ConclusionUWL recorded in primary care is associated with a broad range of cancer sites of early and late-stage.
Highlights
Many developed countries have national strategies to improve survival from cancer
The time to diagnosis was significantly shorter in patients with unexpected weight loss (median 80 days (IQR 26–290)), with a positive skew (mean 181 days, compared to patients without (median 353 (IQR 181-541), p < 0.01) (Supplementary information 2)
Risk of cancer diagnosis following presentation with unexpected weight loss Over the 2 years, the risk of a cancer diagnosis was higher in patients with unexpected weight loss than controls in the three months after the index consultation, but thereafter, the risk of cancer was lower than controls (Fig. 2—left panel, Supplementary information 3)
Summary
Many developed countries have national strategies to improve survival from cancer. A key component is diagnosing cancer earlier.[1]. We aimed to understand the time period of cancer diagnosis and the cancer types detected in primary care patients with unexpected weight loss (UWL) to inform cancer guidelines. Univariable and multivariable time-to-event analyses examined the association between UWL, and all cancers combined, cancer site and stage. Men with UWL (HR 3.28 (2.88–3.73)) and women (1.87 (1.68–2.08)) were more likely than comparators to be diagnosed with cancer within 3 months. In the 3–24 months after presenting with UWL, cancer diagnosis was less likely than in comparators. CONCLUSION: UWL recorded in primary care is associated with a broad range of cancer sites of early and late-stage
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