White, Becky;
(2023)
Early detection of cancer among patients presenting to healthcare services with fatigue.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Many cancer patients are diagnosed after presenting to a GP with ‘non-specific’ symptoms, such as fatigue, which are diagnostically challenging as they are relatively common and can signal many conditions, including cancer. Symptoms like fatigue are not generally supported by referral guidelines for suspected cancer. Yet, GPs must decide which fatigued patients need urgent specialist referral for suspected cancer, or instead, investigation in primary care or ‘watchful wait’ management. Motivated by a literature review identifying the potential to diagnose cancer earlier, I used GP electronic health records (EHRs) to examine short-term cancer risk in cohorts of patients presenting to GPs with new-onset fatigue. I assessed the risk of cancer and specific cancer sites, alongside a wide range of other non-neoplastic diseases, according to patient age and sex, and other presenting symptoms. Overall cancer risk exceeded current UK guideline thresholds (> 3%) for urgent investigation for suspected cancer in older patients presenting with new-onset fatigue alongside other ‘non-specific’ symptoms, such as weight loss and specific abdominal symptoms. Compared to other diseases, cancer was relatively likely in older men (aged 80 years) with fatigue, but not women. Recommendations to prioritise investigating suspected cancer can be supported more strongly in men with fatigue than women. Fatigue presentation alone was not strongly predictive of any single cancer. Moreover, risk of various potentially urgent diseases and those requiring secondary care referral was heightened in some fatigue presenters (e.g. stroke or chronic kidney disease in older men). When secondary care investigation is needed and the working diagnosis is unclear, referral through ‘non-specific symptom pathways’ such as a Rapid Diagnostic Centres could be considered. Future research could compare the risk of different diagnostic outcomes in the presence of multiple diagnostic features (including symptoms, blood test results, and comorbidities), to better discriminate between possible diagnoses in fatigue presenters.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Early detection of cancer among patients presenting to healthcare services with fatigue |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10183908 |
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