Cancer should be at the forefront of GPs minds when older men present with tiredness, say researchers who did an analysis of the main reasons behind the symptom.
A study of health records of almost three quarters of a million patients compared the most common diseases in those were did or did not present with tiredness.
The most striking finding was that in men visited the GP with fatigue, by the age of 80, cancer was the disease with the fourth highest excess risk.
But in women cancer had the 13th highest excess risk in this group, the researchers reported in the British Journal of General Practice.
It suggests GPs should prioritise cancer testing in older men, but not older women, and could help inform national guidelines, the researchers concluded.
Fatigue is so common it is the main complaint in around one in 15 consultations.
To identify patterns, the researchers compared diagnoses in the year after a consultation for 304,914 patients with fatigue and 423,671 without between 2007 and 2017.
They created an infographic of the conditions in men and women that were more commonly linked to tiredness and how that changed with age to help GPs prioritise what to test for.
Among men, patients who presented with fatigue tended to be older than patients who presented without fatigue or registered patients in general, whereas among women the patients who presented with tiredness were slightly younger.
The risk of all cancer was double in men presenting with fatigue compared to those without the symptom, the research showed and 1.4 times higher in women.
Other conditions most strongly linked with fatigue were depression, respiratory tract infections, and sleep disorders and in women, hyperthyroidism.
In men over 80, hypertension and lower respiratory tract infections had the highest excess risk in the fatigue group, followed by all cancers.
‘The ranking of diseases by excess risk in patients who present with fatigue in the current study could inform UK diagnostic guidelines for fatigue and help GPs prioritise diagnostic testing strategies,’ the team lead by University College London concluded.
‘The highest likelihood ranks would include depression, lower and upper RTIs, insomnia and sleep disturbances, hypo/hyperthyroidism (women), and cancer (men).’’
They added: ‘An argument can be made to prioritise investigating cancer in older men (aged over 70 years) with fatigue, in whom it is relatively likely.
‘In older women, safety-netting for cancer or investigation alongside other diagnoses could be more appropriate.’
The reason for higher cancer risk in men with fatigue than women could relate to how the disease presents but also differences in help-seeking patterns, they noted.
The Government will introduce a men’s health strategy to tackle cardiovascular disease, prostate and testicular cancer and mental health, it announced in November last year.
This is of some interest.
But surely two words cast doubt on the meaningfulness of this result: “Prostate” and “cancer”.
Given that 80% of 80 year old men will have histological prostate cancer, is it any surprise that when you investigate these men for fatigue, 7% will be found to have a cancer?
Anyway I haven’t read the paper so maybe this is brilliantly controlled for.