Risk of cancer following primary care presentation with fatigue: a population-based cohort study of a quarter of a million patients, 2022, White et al

Andy

Andy

Retired committee member
Abstract

Background
The management of adults presenting with fatigue presents a diagnostic challenge, particularly regarding possible underlying cancer.

Methods
Using electronic health records, we examined cancer risk in patients presenting to primary care with new-onset fatigue in England during 2007–2013, compared to general population estimates. We examined variation by age, sex, deprivation, and time following presentation.

Findings
Of 250,606 patients presenting with fatigue, 12-month cancer risk exceeded 3% in men aged 65 and over and women aged 80 and over, and 6% in men aged 80 and over. Nearly half (47%) of cancers were diagnosed within 3 months from first fatigue presentation. Site-specific cancer risk was higher than the general population for most cancers studied, with greatest relative increases for leukaemia, pancreatic and brain cancers.

Conclusions
In older patients, new-onset fatigue is associated with cancer risk exceeding current thresholds for urgent specialist referral. Future research should consider how risk is modified by the presence or absence of other signs and symptoms. Excess cancer risk wanes rapidly after 3 months, which could inform the duration of a ‘safety-netting’ period. Fatigue presentation is not strongly predictive of any single cancer, although certain cancers are over-represented; this knowledge can help prioritise diagnostic strategies.

Open access, https://www.nature.com/articles/s41416-022-01733-6
 
Mainly posting for this, my bolding.
The paper said:
Cohort description
Of the 278,821 individuals who had a record of fatigue in primary care between 2007 and 2013, 250,606 (90%) had at least one ‘eligible’ record within the patient’s inclusion period, without either a cancer diagnosis or an ‘ineligible’ fatigue record in the previous year (Fig. 1). These were included in the study cohort. There was a preponderance of women in the cohort (68%), compared to 52% in the general population [32]. The study cohort was also slightly older than the general population. For example, among patients with fatigue subsequently diagnosed with cancer, 49% of men and 45% of women were aged 75 years and over, compared to 37% and 37% in the general population, respectively (Table 1). The study cohort was also slightly less deprived, with 23% in the least deprived quintile compared to 18% of people aged 30 years and over in the general population (Supplementary Appendix 5). Regarding specific subcodes, 0.81% (n = 2,033) of the study cohort had a first fatigue record for either Chronic Fatigue Syndrome (CFS) or post viral fatigue syndrome (PVFS)
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NelliePledge said:
2000 in 250k gives an approx U.K. population with CFS or PVFS diagnosis of 540,000 based on 68 million total population
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But that 250K is a specifically selected cohort, which is likely to have a higher number of those diagnosed with CFS or PVFS, so I'm not sure it can be worked out like that?

Digging into the figures, CFS is given at n=3,024 (0.78%), PVFS at n=636 (0.16%) from "Records of specific fatigue read codes, including all chronic fatigue syndrome and post-viral fatigue syndrome codes, as a proportion of all eligible records of fatigue between 2007-2013". So they seem to be saying that only 3,660 new cases of CFS or PVFS were recorded between 2007 - 13. I think, I could be wrong.
 
In my n=1 and I am not yet over 80, I complained to my primary care doc of increasing fatigue and muscle weakness. I was unable to express to him that it was likely a continuation of my 25 yr career with FM.

My self-diagnosis is that the muscle weakness is probably due to aging muscle (sarcopenia) and the use of muscle relaxants for pain control, which does indeed make muscles weak while the drug is active and the muscles feel weak, too.

It did surprise me, however, that he asked no questions about pain/discomfort in body areas related to a possble cancer diagnosis (cancers: ovarian, lung, bowel, etc.). He did however order a slew of tests to rule out autoimmune diseases. I have had these tests twenty years ago, all negative.

My mother presented with fatigue as the first symptom with lung cancer, in her 80s.

Take away message: ask about cancer.
 
I think it means that the patient will get worse in that time as it becomes obvious it is cancer but they were never the best at explaining themselves.

My father became very fatigued when he first developed cancer but his first blood test showed very low levels of iron which accounted for it.

I reassure myself that blood tests will be off if I develop cancer as I get them checked once a year because of diabetes. I have no idea how I would know if I had cancer otherwise because of the pains and strange symptoms I get all the time. As is typical of ME they are always changing so could all be said to be new onset except that I could have had them years or months ago.

Some things are constant but they are mainly movement, POTS and energy related.
 
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