This study reviews the course of all patients registered at the Saskatoon Cancer Clinic between 1949 and 1951, with histologically proven cancer of the colon or rectum. The data were abstracted, coded and analysed by life-table methods. Follow-up was complete to death or to 1982. There were 403 patients (58.3% were men). Cancer of the rectum accounted for 51% of the total, the sigmoid colon 22% and the cecum 10%. The primary tumour was resected by abdominoperineal resection, hemicolectomy or segmental colectomy in 63% of the patients; colostomy alone was performed in 21%. The overall survival was 31% at 5 years, 24% at 10 years, 15% at 20 years and 7% at 30 years from diagnosis. Many of the deaths in this relatively elderly group of patients were due to causes other than the cancer. Considering cancer-related causes of death only in patients with resectable lesions, the cumulative probability of survival at 5, 10, 20 and 30 years was 63% +/- 4%, 54% +/- 4%, 48% +/- 4% and 47% +/- 6%, respectively (probability +/- 1 standard error), for those without lymphadenopathy, and 14% +/- 3%, 12% +/- 2%, 10% +/- 2% and 9% +/- 3%, respectively, for those with involved nodes. Death from the cancer was rare after 10 years while deaths from competing causes continued to occur, at a near constant rate, for 30 years. The data suggest that the cancer was eradicated in one third of all patients, and in one half of patients in subgroups with no lymphadenopathy or with shallow primary lesions.
Five community-specific interventions to reduce the time to diagnosis after an abnormal breast screen have been evaluated.
Subjects with abnormal screening mammograms in 1998 were assessed through five community pilot projects (N = 1137) and a control random sample assessed elsewhere in BC (N = 1053). The number, types, dates and physician costs of breast-related interventions after an abnormal screen were compared between pilots and control.
The median time to diagnosis for women without a biopsy was reduced from 23 days to 7 days (p = 0.001) in the pilot with facilitated referral to diagnosis. The median time to diagnosis for women with a biopsy was reduced from 57 days to 22-43 days in the pilots. Median physician costs per subject were lower (p = 0.02) in pilots that more frequently used core biopsy to obtain a diagnosis.
Process changes can improve the time to diagnosis after an abnormal breast screen, with similar or lower physician costs per subject. Facilitating the referral process had the greatest impact.
Prediction of outcome after stroke is important for triage decisions, prognostic estimates for family and for appropriate resource utilization. Prognostication must be timely and simply applied. Several scales have shown good prognostic value. In Calgary, the Orpington Prognostic Score (OPS) has been used to predict outcome as an aid to rehabilitation triage. However, the OPS has not been assessed at one week for predictive capability.
Among patients admitted to a sub-acute stroke unit, OPS from the first week were examined to determine if any correlation existed between final disposition after rehabilitation and first week score. The predictive validity of the OPS at one week was compared to National Institute of Health Stroke Scale (NIHSS) score at 24 hours using logistic regression and receiver operator characteristics analysis. The primary outcome was final disposition after discharge from the stroke unit if the patient went directly home, or died, or from the inpatient rehabilitation unit.
The first week OPS was highly predictive of final disposition. However, no major advantage in using the first week OPS was observed when compared to 24h NIHSS score. Both scales were equally predictive of final disposition of stroke patients, post rehabilitation.
The first week OPS can be used to predict final outcome. The NIHSS at 24h provides the same prognostic information.