The pathway and characteristics of patients with non-specific symptoms of cancer: a systematic review

Abstract

Background Non-specific symptoms are common and often sign of a non-serious disease. Because of this, patients with non-specific symptoms of cancer (NSSC) present a challenge for general practitioners (GP). Studies describing characteristics of patients with NSSC have been done after fast-track pathways were created to diagnose and treat patients with NSSC. This study reviews characteristics of patients with NSSC and their patient pathways. Materials and methods Database searches of Embase, Cochrane, PubMed, Cinahl and Web of Science were performed. Search terms used were cancer, patient pathway, and NSSC with their synonyms. The flow diagram Preferring Reporting Items for Systematic Review was applied to the systematic search. The Newcastle–Ottawa Assessment Scale (NOS) was used to compare the quality of the included studies. Results Twelve studies met the inclusion criterias. All studies were considered to be of high methodological quality. Patient Pathway: 11–35% of patients were diagnosed with cancer. Median number of days through diagnostic process was 7–10. Patient Characteristics: The most prevalent cancers included hematological-(14–30%), gastrointestinal-(13–23%) and lung cancers (13%). Rheumatological, musculoskeletal and gastrointestinal diseases were among the most common non-malignant diseases diagnosed. Weight loss, fatigue, pain and loss of appetite were the most common symptoms. Cardiovascular diseases, lung diseases, diabetes and previous diagnosed cancer were the most common comorbidities. Mean age of included patients was 60–72 years. Conclusion Limited number of studies were found and they lacked sufficient heterogenic data to conduct a metaanalysis. Symptoms, diagnoses, age and gender were described with some heterogenic results. Further studies should be conducted to gather broader knowledge about patients with NSSC.

Patients from general practice with non-specific cancer symptoms: a retrospective study of symptoms and imaging

“…These results were in keeping with the literature, for instance Chapman et al found the three most common cancers to be GI-cancers (upper and lower) (35%), lung (22%), and haematological (13%) 24 . Several other national and international studies found comparable results albeit with variations in numbers 25,26,29,34 .…”

“… 24 Several other national and international studies found comparable results, albeit with variations in numbers. 25 , 26 , 29 , 34 …”

Risk of cancer and serious disease in Danish patients with urgent referral for serious non-specific symptoms and signs of cancer in Funen 2014–2021

“…A number of NSSC-CPP studies has previously been conducted in Denmark [ 43 ]. However, these have almost exclusively been based on the early years of the urgent referral programme from 2011 up until the end of 2015 with timeframes usually of 1–3 years [ 24 – 30 , 44 , 45 ], the latter of which limits the possibilities of looking at differences over longer periods of time.…”

Gastric cancer with enhanced myogenesis is associated with less cell proliferation, enriched epithelial-to-mesenchymal transition and angiogenesis, and poor clinical outcomes

“…Despite an increase in 5-year survival rates from 15% in the 1970s to 33% in the 2010s, these rates remain relatively Am J Cancer Res 2024;14(1):355-367 low compared to other cancer types [2]. Gastric cancer is often marked by non-specific symptoms, and it often progresses unnoticed due to the delay in onset of clinically detectable symptoms [3]. When the disease is diagnosed at the metastatic stage, the prognosis is generally poor and radical surgery is not indicated [4].…”