BRIGHTLIGHT Reveals ‘Broad Spectrum’ Of Presenting Symptoms In Teenage Cancer Patients

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: A study of adolescents and young adults with cancer suggests that these patients present with a wide range of symptoms and at higher rates than previously estimated from electronic health records (EHRs). 

For the BRIGHTLIGHT cohort study, 803 English cancer patients aged 12–24 years at time of diagnosis in 2012–2015 were interviewed on their presenting symptoms and the interval between symptom onset and help-seeking. This information was then collated with records from the national cancer registry. 

As reported in JAMA Network Open, the most common presenting symptoms were lump or swelling (52%), extreme tiredness (38%), unexplained pain (34%), night sweats (24%), lymphadenopathy (24%) and weight loss (24%).  

Less common symptoms included headache (16%), dizziness (16%), rash or itching (12%), limping or mobility issues (10%) and bleeding or bruising (9%), with smaller numbers experiencing other symptoms, such as menstrual changes (7%), recurrent infection (6%), mole changes (5%), loss of vision (3%) and fits or seizures (2%). 

The study investigators found that the number of presenting symptoms varied with the diagnosis. For example, 86% of leukaemia patients and 77% of those with lymphoma had two or more symptoms at time of presentation compared with just 31% of melanoma patients. 

There were 352 unique symptom combinations identified in the cohort, with the 10 most common symptom combinations representing 38% of the patients. 

And the prevalence of symptoms across tumour types differed. Lumps or swelling occurred in more than half of the patients with lymphoma, germ cell cancer, carcinoma, bone tumours or soft tissue sarcoma, whereas other symptoms tended to be tumour-specific, such as limping or mobility issues, which affected 42% of bone tumour patients, and bruising or bleeding in 39% of those with leukaemia. 

Almost half (48%) of patients waited more than 2 weeks before seeking help for their presenting symptom, with 27% of patients waiting for more than 1 month and 12% more than 3 months. But this varied significantly by symptom, with a 1-month or greater interval reported for 6% of patients experiencing seizures and 43% of those with recurrent infections. 

“The degree of observed variation in time to help-seeking by presenting symptom is not large enough to enable specific targeting within awareness campaigns”, the authors say. 

Talking to medwireNews, lead author Monica Koo, from University College London in the UK, emphasized the “substantially higher symptom prevalence” in the BRIGHTLIGHT study cohort compared with earlier estimates created from EHRs. 

“If symptoms are captured differently in medical records among those diagnosed with cancer compared to those who [do not] have cancer, we might be under- or over-estimating a symptom’s positive predictive value for cancer, which is currently considered to be extremely low in this age group”, she commented. 

“Further work in this area could contribute to early diagnosis strategies for younger people, who often experience prolonged times to diagnosis.” 

Reference  

Koo MM, Lyratzopoulos G, Herbert A, et al. Association of self-reported presenting symptoms with timeliness of help-seeking among adolescents and young adults with cancer in the BRIGHTLIGHT Study. JAMA Netw Open; 3: e2015437. Published online 3 September 2020. doi:10.1001/jamanetworkopen.2020.15437