Underlying cancer risk among patients with fatigue and other vague symptoms: a population-based cohort study in primary care

BACKGROUND: Presenting to primary care with fatigue is associated with slightly increased cancer risk, although it is unknown how this varies in the presence of other ‘vague’ symptoms. AIM: To quantify cancer risk in patients with fatigue who present with other ‘vague’ symptoms in the absence of ‘alarm’ symptoms for cancer. DESIGN AND SETTING: Cohort study of patients presenting in UK primary care with new-onset fatigue during 2007–2015, using Clinical Practice Research Datalink data linked to national cancer registration data. METHOD: Patients presenting with fatigue without co-occurring alarm symptoms or anaemia were identified, who were further characterised as having co-occurrence of 19 other ‘vague’ potential cancer symptoms. Sex- and age-specific 9-month cancer risk for each fatigue–vague symptom cohort were calculated. RESULTS: Of 285 382 patients presenting with new-onset fatigue, 84% (n = 239 846) did not have co-occurring alarm symptoms or anaemia. Of these, 38% (n = 90 828) presented with ≥1 of 19 vague symptoms for cancer. Cancer risk exceeded 3% in older males with fatigue combined with any of the vague symptoms studied. The age at which risk exceeded 3% was 59 years for fatigue–weight loss, 65 years for fatigue–abdominal pain, 67 years for fatigue–constipation, and 67 years for fatigue–other upper gastrointestinal symptoms. For females, risk exceeded 3% only in older patients with fatigue–weight loss (from 65 years), fatigue–abdominal pain (from 79 years), or fatigue–abdominal bloating (from 80 years). CONCLUSION: In the absence of alarm symptoms or anaemia, fatigue combined with specific vague presenting symptoms, alongside patient age and sex, can guide clinical decisions about referral for suspected cancer.