Clinical features of metastatic cancer in primary care: a case-control study using medical records
British Journal of General Practice
Royal College of General Practitioners
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BACKGROUND: How metastatic cancer initially presents is largely unknown. AIM: To identify clinical features of metastatic cancer in primary care. DESIGN AND SETTING: Case-control study in 11 general practices in Devon, UK. METHOD: Cases of patients who had died with metastatic breast, colorectal, or prostate cancer were selected. In addition, two control groups were formed of patients with the same primary cancer but without metastases ('cancer controls') and patients without cancer ('healthy controls'), matched for age, sex, and practice. All symptoms, signs, and laboratory test abnormalities in the year before metastasis were identified. The primary analysis used conditional logistic regression. RESULTS: In total, 162 cases, 152 cancer controls, and 145 healthy controls were studied. Common symptoms associated with cancer were: vomiting, 40 (25%) cases and 13 (9%) cancer controls (multivariable odds ratio [OR] 3.5, 95% confidence interval [CI] = 1.3 to 9.4, P = 0.011); low back pain, 38 (24%) cases and 17 (11%) cancer controls (OR 2.5, 95% CI = 1.1 to 5.6, P = 0.032); loss of appetite, 32 (20%) cases and nine (6%) cancer controls (OR 4.0, 95% CI = 1.2 to 13.2, P = 0.021); and shoulder pain, 27 (17%) cases and eight (5%) cancer controls (OR 5.3, 95% CI = 1.6 to 18, P = 0.007). Groin pain was uncommon, but strongly associated (16 [10%] cases and one [1%] cancer control [OR 10, 95% CI = 1.2 to 82, P = 0.032]), as was pleural disease (nine [6%] cases and one [1%] cancer control [OR 10, 95% CI = 1.1 to 92, P = 0.038]). CONCLUSION: These features of disseminated cancer have been reported before in studies from secondary care, but the scarcity of specific symptoms (such as local pain) and the fairly common occurrence of non-specific symptoms (vomiting and loss of appetite) is important and may explain delays in the diagnosis of metastases.
The study authors received funding from the National Institute for Health Research (NIHR) School for Primary Care Research funding scheme. Additionally, William Hamilton was funded through a National Coordinating Centre for Research Capacity Development (NCCRCD) post-doctoral fellowship. Jacqueline Barrett was funded by an unrestricted grant from Macmillan to William Hamilton. This research was also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula at Royal Devon and Exeter NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily of the NHS, NIHR, or the Department of Health. The study sponsor was the University of Bristol. The authors were independent from the funder and sponsor, who had no role in conduct, analysis, or the decision to publish.
This is the final version of the article. Available from Royal College of General Practitioners via the DOI in this record.
Vol. 65 (637): e516 - e522
Place of publication