Quantifying the risk of non-Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years: a large case–control study using electronic records

Assessing risk and improving survival in lymphoma

“…Nonetheless, risk estimates for cases aged ≥60 years provided in the reports are important, as HL survival is consistently inferior for older cases and earlier referral for specialist review may help abrogate this phenomenon. Similarly, the outcomes for older patients with NHL lag behind those who are younger and the age distribution for NHL in the report by Shephard et al (78.5% of NHL occurring in ≥60-yearolds 8 ) is consistent with Eurocare-5 (60% in the ≥65-year-old population and 80% in ≥55-year-olds). 4 The similar age demographic further validates the symptom profile in NHL with its attendant PPVs, supporting the early referral of such cases.…”

“…The reported low incidence of B symptoms (weight loss 4%, excessive sweating 1.2%, and fever 1.2%) in the NHL study 8 contrasts to higher frequencies reported in studies of aggressive NHL (41% 10 ) and indolent NHL (FL,19% 11 ) and those observed in our personal experience. A similar low level of such systemic symptoms in the HL report 9 contrasts with the international prognostic collaboration report of 71%.…”

“…The historical reports indicating GPs are able to distinguish malignant from benign lymphadenopathy are important and the PPVs determined for masses in older patients by Shephard's group develop this further. 8,9 However, this should be considered in the context of recent developments in national referral practices including the cancer (2-week wait) referral pathway from which only a relatively small proportion (in the region of 10% in our centre) of suspected lymphoma referrals prove to be either NHL or HL. While Shephard et al's studies could not specifically address size from the CPRD data, lymphadenopathy ≥2 cm or rapid enlargement should be considered as urgent red flag signs and prompt referral would be judicious.…”

“…The studies by Shephard and colleagues 8,9 provide an important insight in to the presentation of NHL and HL in the primary care setting and can be used to inform referral practices, most notably in older patients. In tandem with the studies' insights, a specialised learning tool dedicated to the subject of lymphoma in the primary care sector has been produced by the Royal College of General Practitioners and the Lymphoma Association and should be a valuable resource.…”

“…In this issue, Shephard and colleagues report two large case-control studies that determine symptom and sign risk profiles for patients in the primary care setting who go on to develop NHL (n = 4362) 8 or HL (n = 283), 9 respectively. This is the first approach of this scale performed in the primary care sector to address the presenting features of lymphoma.…”