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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