Patients and researchers agree: Physicians frequently overlook lymphoma, myeloma and leukemia in the differential diagnosis of common symptoms, leading to unnecessary delays in treatment.
Addressing the problem may require development of pathways for better evaluation of vague, common or unexplained symptoms and greater awareness on the part of patients of their own normal states and persistence in obtaining a diagnosis and treatment, according to a recent study in the British Journal of General Practice.
Doctor talking with patient. Source: Getty
While the current study relied on data from the UK’s Heaematological Malignancy Research Network (HMRN), similar findings have been published based on Australian, Canadian and US databases.
Similar to previous studies, the researchers determined that, while some blood disorders were diagnosed within 10 weeks of initial presentation, others took a year. Acute myeloid leukemia had the shortest average time to diagnosis at 41 days, with an interquartile range (IQR) of 17 to 85 days. Diffuse large B-cell lymphoma took a mean of 98 days for diagnosis, IQR of 53 to 192 days, and, on average, 163 days elapsed before a diagnosis of myeloma was made, with an IQR of 84 days to 306 days.
More than a third of patients visited their primary care physician at least three times before being referred to a hospital for testing. Few primary care physicians initially considered hematological cancers as a likely explanation for symptoms, especially if the symptoms progressed slowly or were not acute.
About 40% of patients with diffuse large B-cell lymphoma were not diagnosed until they had an emergency admission, at which point most had advanced disease, according to a previous analysis of the UK HMRN.
About one-third of patients in the current study were considered asymptomatic at diagnosis, and found out they had a hematologic malignancy, primarily chronic lymphocytic leukemia and myeloproliferative neoplasms, because of abnormal laboratory results from blood draws connected with other comorbidities or routine health assessments. Patients with other kinds of lymphoma often had blood tests with normal or inconclusive results.
“Asymptomatic” might not accurately capture what patients were saying to providers prior to their diagnosis, however. While current diagnostic tools focus on signs such as sudden weight loss, swollen lymph nodes and night sweats, patients frequently had less obvious complaints.
The majority of patients reported extreme tiredness and ongoing infections. An unexpected number, given the current diagnostic criteria, reported significant pain.
“Patients and GPs can easily put the symptoms of blood cancers like lymphoma down to the ageing process or harmless conditions,” said Alasdair Rankin, MD, director of Research and Patient Experience at study sponsor Bloodwise. “It’s vital that [primary care physicians] are made aware of the signs that could indicate blood cancers and that patients are reassured that it’s OK to keep seeking help if they continue to experience unusual, ongoing or unexplained symptoms.”