In this issue of the BJGP, Koshiaris and colleagues present a primary care electronic health records study that examines the combined predictive value for multiple myeloma of presenting symptoms and blood tests commonly used in primary care.1 Building on previous related research,2 this study reports important new evidence that could help doctors to both shorten diagnostic intervals in patients with this (very hard-to-suspect) cancer and minimise the need for specialist assessment in those unlikely to have the disease. A key finding is that in patients with persistent back or bone pain the combination of normal full-blood count and normal erythrocyte sedimentation rate/plasma viscosity can help to reasonably rule out the risk of multiple myeloma.1
THE CURRENT EVIDENCE BASE
Research about the prognostic value of presenting symptoms for cancer based on primary care patient records has been accumulating since the mid-2000s.3 Currently (mid-2018) there is a body of about 50 studies from different research groups, chiefly but not solely from England. Much of this expanding evidence base has underpinned the publication of the 2015 NICE guidelines for the referral or investigation of 157 common symptomatic presentations in adults.4 Taken together, these collective research efforts (many of which have been published in the BJGP) represent a commendable achievement that has enhanced medical knowledge very substantially. Certain limitations in the …
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