weight loss in the elderly

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This symptom should not be ignored. A weight loss of 5% in 6 months will have some pathology associated with the weight loss in 75-80% of cases. Malignancy may occur in up to 20% of cases. Weight loss associated with depression occurs in 10% of cases.

A systematic review was undertaken relating to weight loss and cancer risk (1):

  • total of 25 studies were included, with 23 (92%) using primary care records
    • of these, 20 (80%) defined weight loss as a physician’s coding of the symptom; the remainder collected data directly
    • one defined unexplained weight loss using objective measurements
    • positive associations between weight loss and cancer were found for 10 cancer sites:
      • prostate, colorectal, lung, gastro-oesophageal, pancreatic, non-Hodgkin’s lymphoma, ovarian, myeloma, renal tract, and biliary tree
      • sensitivity ranged from 2% to 47%, and specificity from 92% to 99%, across cancer sites
      • positive predictive value for cancer in male and female patients with weight loss for all age groups >= 60 years exceeded the 3% risk threshold that current UK guidance proposes for further investigation
      • risk with weight loss increases when it presents alongside another clinical feature suggesting an individual cancer site, and with increasing age

The study authors concluded that a primary care clinician's decision to code for weight loss is highly predictive of cancer. For such patients, urgent referral pathways are justified to investigate for cancer across multiple sites.


Last edited 08/2020