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Meta-Analysis
. 2018 May;68(670):e311-e322.
doi: 10.3399/bjgp18X695801. Epub 2018 Apr 9.

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

Brian D Nicholson  1 , William Hamilton  2 , Jack O'Sullivan  1 , Paul Aveyard  1 , Fd Richard Hobbs  1
Affiliations
Meta-Analysis

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

Brian D Nicholson et al. Br J Gen Pract. 2018 May.

Abstract

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.

Keywords: cancer; diagnosis; primary care; systematic review; weight loss.

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Figures

Figure 1.
Figure 1.
Graphical summary of QUADAS-2 assessment of risk of bias and applicability concerns presented as percentages across all 25 included studies.
Figure 2.
Figure 2.
Receiver operating characteristic plot of diagnostic value of unexplained weight loss for different cancers.
See this image and copyright information in PMC

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