Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis

  • Nicholson B
  • Hamilton W
  • O’Sullivan J
 et al. 
  • 4


    Mendeley users who have this article in their library.
  • 0


    Citations of this article.


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.

Get free article suggestions today

Mendeley saves you time finding and organizing research

Sign up here
Already have an account ?Sign in

Find this document


  • Brian D Nicholson

  • William Hamilton

  • Jack O’Sullivan

  • Paul Aveyard

  • FD Richard Hobbs

Cite this document

Choose a citation style from the tabs below

Save time finding and organizing research with Mendeley

Sign up for free