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Independents' Day

GPs urged to suspect cancer in over-60s with weight loss

GPs should suspect cancer in patients over 60 who present with weight loss and refer them rapidly for further investigations, a meta-analysis has advised.

The analysis found that a GP’s decision to code for weight loss in older patients was highly predictive for cancer and should prompt an urgent referral for further investigation.

The analysis, carried out by researchers at the Universities of Oxford and Exeter, reviewed 25 different studies that looked at the association between weight loss and cancer in primary care.

The analysis found a positive association with weight loss in ten different types of cancer, including prostate, colorectal, ovarian and myeloma. In patients aged 60 or over with weight loss, the likelihood that they had cancer was up to 7% in women and 14% in men, above the NICE threshold of 3% for urgent investigation of suspected cancer.

The authors said in the paper: ‘This review suggests that patients aged ≥60 years presenting to primary care settings with weight loss that prompts a clinical record entry warrant rapid investigation for possible cancer.’

They suggested that the findings will be of note to policymakers in developing symptom-based referral pathways for suspected cancer.

The authors also noted the low sensitivity of weight loss in predicting cancer, cautioning that the absence of weight loss should not rule cancer out.

RCGP clinical lead for cancer, Dr Richard Roope, said: ‘These important findings present strong evidence of the correlation between significant unexplained weight loss and many cancers, and should certainly be taken on board as clinical guidelines for GPs and healthcare professionals are updated and developed.

‘We agree with the researchers’ recommendations that GPs need better access to diagnostic tools in the community across the UK so that we can appropriately refer patients to either rule out or confirm a diagnosis of cancer, as currently our access is amongst the lowest in Europe.'

He added: ‘We hope the pilot of "one stop" cancer clinics, announced last week by NHS England, in addition to the roll out of the Faster Diagnosis Standard programme, will be a step to achieving this across the country.’

NHS England announced last week that GPs would be able to refer patients with non-specific symptoms to ‘one-stop shop’ cancer clinics across 10 sites in England in order to secure quicker investigation and diagnosis for suspected cancer.

Br J Gen Pract 2018; available online 10th April

Readers' comments (13)

  • I have practised in this way for my whole 40 year career. I don’t need reminding by the inhabitants of an academic paper mill.

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  • 10 types of cancer-10 referrals then!
    Lack of weight loss does not exclude cancer!!
    Is this research for daily mil readers or doctors!

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  • Jones the Tie

    sigh...ooh hang on how do I suck those eggs over there? I've no idea . I need some ivory tower rubbish to teach me... back on planet earth ..

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  • Are the academic dumbing down isn't this basic medicine.The whole point in a cut price health system is access to diagnosics.Yes the UK less scanners per head of population than almost everyone else, less hospital beds and of course less Drs pe head of population than most others.Remind me how we going to do this with those facts pointing to massive underfunding in the health system.Now how much does a good MRI scanner cost again, is it still £30 million or can we get one from ebay now.

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  • MRI scanner cost includes running and maintaining it of course, lets no forget staffing it.

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  • Oh wow, breaking news — weightloss could be cancer. You’ve read it here first 😂

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  • Vinci Ho

    Thank you
    My mother is a woman
    My late father was a man

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  • One problem is that many just think weight loss = referral for CT chest abdo pelvis, forgetting the old fashioned history and examination which usually leads to more appropriate targeted investigation.
    I have a friend who is a radiologist who tells me that radiology services are overwhelmed by demand for this blunderbuss approach which has a very low yield.

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  • David Banner

    So your obese 65 yr old has lost a stone in 3 months due to “lifestyle change” and is chuffed. You ignore it. 9 months later he is diagnosed with terminal bowel cancer. Then you receive the complaint that you failed to do a 2WW referral when he could have been successfully treated. After all, didn’t you see the “weight loss in the elderly” advice in 2018?
    The cancer retrospectoscope will skewer many GPs who “failed” to 2WW refer patients with the vaguest symptoms. The end result will be OPDs swamped with inappropriate referrals...... and who’s fault will that be???

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  • Bornjovial

    Medicine is not an exact science- if it were algorithms would have replaced us by now.
    Unplanned/unexpected weight loss is always a very important symptom when assessing the elderly.
    NNH (unnecessary tests and worry) maybe more than NNT (actual cancer) and would need to be formally assessed in a study before including it in guidelines.

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