Background: Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about investigation in primary care. Aim(s): 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(s): Studies reporting 2 x 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. Result(s): 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 >=6 0 years exceeded the 3% risk threshold that current UK guidance proposes for further investigation. Conclusion(s): 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.Copyright © British Journal of General Practice.
CITATION STYLE
B.D., N., W., H., J., O., P., A., & F.D.R., H. (2018). Weight loss as a predictor of cancer in primary care: A systematic review and meta-analysis. British Journal of General Practice, 68(670), e311–e322. Retrieved from http://bjgp.org/content/68/670/e311/tab-pdf
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