Author(s): Williams S.; Ross A.; Arumainathan A.; Huang R.; Singh V.
Source: British Journal of Haematology; Apr 2018; vol. 181 ; p. 89
Publication Date: Apr 2018
Publication Type(s): Conference Abstract
Available at British journal of haematology – from Wiley Online Library Full Collection
Abstract:An increasing number of referrals to haemato-oncology clinics are for isolated night sweats. A significant proportion of these are on a 2-week pathway. Such referrals can cause significant anxiety and trigger multiple investigations, including imaging. Only a minority of patients with lymphoma present solely with sweats. In addition, sweats may indicate other non-haematological aetiologies. The positive predictive value of isolated night sweats for a haematological malignancy is not known. NICE guidance recommends exclusion of malignancy in patients with unexplained lymphadenopathy or splenomegaly, where night sweats are an associated symptom, but not the principal cause for referral. We undertook a retrospective review of all referrals to haemato-oncology clinics in two tertiary referral centres in Merseyside, that included night sweats as a reason for referral. We included all patients (n = 137) referred over a two-year period (Jan 2015-Dec 2016). We analysed referral information, and subsequent pathways and outcomes. We noted the presence of associated symptoms and severity of sweats. Nine patients did have a previous diagnosis of a haematological cancer, but none had evidence of relapse or significant progression. Of the 128 remaining patients, 40 had night sweats as their sole pre-senting symptom, with no clinical or imaging abnormalities. Two patients were diagnosed with an IgM MGUS requiring follow-up. The remaining 38 patients were discharged back to primary care. Five patients reported spontaneous resolution of sweats prior to clinic visit. Forty-nine patients did present with additional symptoms and signs, but these were not haematology-specific. One such patient was diagnosed with a low-grade NHL, and another with lung cancer. Thirty-four patients did have associated lymphadenopathy and/or splenomegaly and/or an abnormal full blood count. Of these, 11 patients were diagnosed with a haematological malignancy. Two patients were found to have a non-haematological cancer. In our study, night sweats in the absence of associated symptoms or laboratory abnormalities, was a poor predictor of a significant haematological malignancy (0%). Conversely, the presence of associ-ated symptoms/signs did signify an underlying malignancy in a sig-nificant proportion of patients (40%). In the light of our findings, we suggest that referral of patients with isolated night sweats for exclusion of lymphoma requires re-assessment. These referrals generate much patient anxiety and can lead to multiple investigations, including unnecessary radiation exposure. In addition, such referrals influence clinic capacity, affect time and resources, and may affect waiting times for more appropriate referrals.