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- Title
Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records.
- Authors
Shephard, Elizabeth A.; Neal, Richard D.; Rose, Peter W.; Walter, Fiona M.; Hamilton, Willie
- Abstract
<bold>Background: </bold>Leukaemia is the eleventh commonest UK cancer. The four main subtypes have different clinical profiles, particularly between chronic and acute types.<bold>Aim: </bold>To identify the symptom profiles of chronic and acute leukaemia in adults in primary care.<bold>Design and Setting: </bold>Matched case-control studies using Clinical Practice Research Datalink records.<bold>Method: </bold>Putative symptoms of leukaemia were identified in the year before diagnosis. Conditional logistic regression was used for analysis, and positive predictive values (PPVs) were calculated to estimate risk.<bold>Results: </bold>Of cases diagnosed between 2000 and 2009, 4655 were aged ≥40 years (2877 chronic leukaemia (CL), 937 acute leukaemia (AL), 841 unreported subtype). Ten symptoms were independently associated with CL, the three strongest being: lymphadenopathy (odds ratio [OR] 22, 95% confidence interval [CI] = 13 to 36), weight loss (OR 3.0, 95% CI = 2.1 to 4.2), and bruising (OR 2.3, 95% CI = 1.6 to 3.2). Thirteen symptoms were independently associated with AL, the three strongest being: nosebleeds and/or bleeding gums (OR 5.7, 95% CI = 3.1 to 10), fever (OR 5.3, 95% CI = 2.7 to 10), and fatigue (OR 4.4, 95% CI = 3.3 to 6.0). No individual symptom or combination of symptoms had a PPV >1%.<bold>Conclusion: </bold>The symptom profiles of CL and AL have both overlapping and distinct features. This presents a dichotomy for GPs: diagnosis, by performing a full blood count, is easy; however, the symptoms of leukaemia are non-specific and of relatively low risk. This explains why many leukaemia diagnoses are unexpected findings.
- Subjects
LEUKEMIA diagnosis; ELECTRONIC health records; LOGISTIC regression analysis; LYMPHADENITIS; SYMPTOMS; AGE distribution; COMPARATIVE studies; LEUKEMIA; LITERATURE; RESEARCH methodology; MEDICAL quality control; MEDICAL cooperation; PRIMARY health care; RESEARCH; RESEARCH funding; RISK assessment; SURVIVAL; EVALUATION research; CASE-control method; ACUTE diseases; ODDS ratio
- Publication
British Journal of General Practice, 2016, Vol 66, Issue 644, pe182
- ISSN
0960-1643
- Publication type
journal article
- DOI
10.3399/bjgp16X683989