Heading 1

Complex Problem Solving

A cohort study investigated the excess short-term incidence of 237 diseases in patients who presented to English primary care with fatigue, compared with patients who presented without fatigue. The study used Clinical Practice Research Datalink data linked to hospital episodes and national cancer registration data. Disease-specific 12-month risk by sex was modelled and the age-adjusted risk calculated.
There were 304,914 people in the fatigue group and 423,671 in the non-fatigue group.
127 of 237 diseases studied were more common in men who presented with fatigue than in men who did not, and 151 were more common in women who presented with fatigue.
Diseases most strongly associated with fatigue included: depression; respiratory tract infections; insomnia; and hypo/hyperthyroidism (women only).
By age 80 years, cancer was the third most common disease and had the fourth highest absolute excess risk in men who presented with fatigue (fatigue group: 7.01%, 95% confidence interval [CI] = 6.54 to 7.51; non-fatigue group: 3.36%, 95% CI = 3.08 to 3.67; absolute excess risk 3.65%). In women, cancer remained relatively infrequent; by age 80 years it had the thirteenth highest excess risk in patients who presented with fatigue.

Based on these findings, consider prioritising cancer investigation in older men presenting with fatigue.
Reflect on how you manage other patients presenting with fatigue. Could an initial whole person approach including a focus on sleep and mood, potentially help to avoid over-investigation?