dc.contributor.author | Shephard, EA | |
dc.contributor.author | Neal, RD | |
dc.contributor.author | Rose, PW | |
dc.contributor.author | Walter, FM | |
dc.contributor.author | Hamilton, W | |
dc.date.accessioned | 2016-05-27T09:18:52Z | |
dc.date.issued | 2015-05-01 | |
dc.description.abstract | BACKGROUND: Non-Hodgkin lymphoma (NHL) is the sixth most common cancer in the UK; approximately 35 people are diagnosed and 13 die from the disease daily. AIM: To identify the primary care clinical features of NHL and quantify their risk in symptomatic patients. DESIGN AND SETTING: Matched case-control study using Clinical Practice Research Datalink patient records. METHOD: Putative clinical features of NHL were identified in the year before diagnosis. Results were analysed using conditional logistic regression and positive predictive values (PPVs). RESULTS: A total of 4362 patients aged ≥40 years, diagnosed with NHL between 2000 and 2009, and 19 468 age, sex, and general practice-matched controls were studied. Twenty features were independently associated with NHL. The five highest risk symptoms were lymphadenopathy, odds ratio (OR) 263 (95% CI = 133 to 519), head and neck mass not described as lymphadenopathy OR 49 (95% CI = 32 to 74), other mass OR 12 (95% CI = 10 to 16), weight loss OR 3.2 (95% CI = 2.3 to 4.4), and abdominal pain OR 2.5 (95% CI = 2.1 to 2.9). Lymphadenopathy has a PPV of 13% for NHL in patients ≥60 years. Weight loss in conjunction with repeated back pain or raised gamma globulin had PPVs >2%. CONCLUSION: Unexplained lymphadenopathy in patients aged ≥60 years produces a very high risk of NHL in primary care. These patients warrant urgent investigation, potentially sooner than 6 weeks from initial presentation where the GP is particularly concerned. | en_GB |
dc.description.sponsorship | This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10045). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Fiona M Walter is part-funded by a NIHR Clinician Scientist award. Richard D Neal is part-funded by Public Health Wales and Betsi Cadwaladr University Health Board. | en_GB |
dc.identifier.citation | Vol. 65 (634): e281 -e288 | en_GB |
dc.identifier.doi | 10.3399/bjgp15X684793 | |
dc.identifier.uri | http://hdl.handle.net/10871/21714 | |
dc.language.iso | en | en_GB |
dc.publisher | Royal College of General Practitioners | en_GB |
dc.relation.url | http://www.ncbi.nlm.nih.gov/pubmed/25918332 | en_GB |
dc.subject | cancer | en_GB |
dc.subject | clinical features | en_GB |
dc.subject | diagnosis | en_GB |
dc.subject | lymphadenopathy | en_GB |
dc.subject | non-Hodgkin lymphoma | en_GB |
dc.subject | primary health care | en_GB |
dc.subject | Adult | en_GB |
dc.subject | Age Factors | en_GB |
dc.subject | Aged | en_GB |
dc.subject | Electronic Health Records | en_GB |
dc.subject | Female | en_GB |
dc.subject | Great Britain | en_GB |
dc.subject | Humans | en_GB |
dc.subject | Lymphoma, Non-Hodgkin | en_GB |
dc.subject | Male | en_GB |
dc.subject | Middle Aged | en_GB |
dc.subject | Odds Ratio | en_GB |
dc.subject | Primary Health Care | en_GB |
dc.subject | Retrospective Studies | en_GB |
dc.subject | Risk Assessment | en_GB |
dc.subject | Survival Rate | en_GB |
dc.title | Quantifying the risk of non-Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a large case-control study using electronic records | en_GB |
dc.type | Article | en_GB |
exeter.place-of-publication | England | |
dc.description | This is the author accepted manuscript. The final version is available from Royal College of General Practitioners via the DOI in this record. | en_GB |
dc.identifier.journal | British Journal of General Practice | en_GB |