Night sweats and haematological malignancies: Are ‘sweats’ truly a ‘red flag’ symptom? An insight into 2-week-wait haemato-oncology referrals at St Bartholomew's Hospital, London, UK

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Haematological cancers, which include leukaemia, myeloma, Hodgkin's and non-Hodgkin's lymphomas, account for over 40,000 new diagnoses every year.1,2 The 2-week-wait referral pathway is available to primary care to refer suspected malignancies for further investigation and assessment, however key reasons for 2-week-wait referrals include subjective measures like sweats.3 Patients referred to 2-week-wait haematology clinics at St Bartholomew's Hospital with ‘sweats’ between May and December 2018 were identified (n = 51) and sub-divided into three groups – Group A, who presented with sweats only (n = 14); Group B, presenting with sweats plus other B symptoms (n = 22); and Group C, experiencing sweats plus adenopathy and/or lymphocytosis (n = 15). Amongst the patients included in the study, we found a low prevalence of classically described ‘drenching night sweats’ (A = 35.7%, B = 63.6%, C = 53.3%). Most patients were examined (A = 92.9%, B = 90.9%, C = 100%) and had follow-up blood tests (A = 92.9%, B = 95.5%, C = 100%) or imaging (A = 57.1%, B = 90.9%, C = 66.7%), and we explored the results of these in each group. Nobody received a diagnosis of malignancy in group A (0%) versus two patients in group B (9.1%) and two in group C (13.3%). Interestingly, most patients were discharged or diagnosed with viral illness, tuberculosis, human immunodeficiency virus (HIV), rheumatological diseases or anaemia. In conclusion, ‘sweats’ is a poorly defined term associated with several differential diagnoses. Thus, referrals may cause distress for patients as well as significantly impact NHS resources. A clearer definition would be beneficial, and further studies should be conducted to explore the association of ‘sweats’ and other signs and symptoms with haematological cancers. Haematological Cancer. Manchester Cancer Research Centre. https://www.mcrc.manchester.ac.uk/research/disease-sites/haematological-cancer/#:∼:text=Haematological%20cancers%20are%20those%20that,the%20type%20of%20cell%20affected [Accessed 20 October 2023]. Haematological cancers – recognition and referral. NICE – National Institute for Health and Care Excellence. February 2021. https://cks.nice.org.uk/topics/haematological-cancers-recognition-referral/ [Accessed 20 October 2023]. Haematology 2WW. GP Gateway. 17 March 2023. https://www.coventryrugbygpgateway.nhs.uk/pages/haematology/ [Accessed 20 October 2023].

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