Diagnosis delay and follow-up strategies in colorectal cancer. Prognosis implications: a study protocol.

BACKGROUND: Controversy exists with regard to the impact that the different components of diagnosis delay may have on the degree of invasion and prognosis in patients with colorectal cancer. The follow-up strategies after treatment also vary considerably. The aims of this study are: a) to determine if the symptoms-to-diagnosis interval and the treatment delay modify the survival of patients with colorectal cancer, and b) to determine if different follow-up strategies are associated with a higher survival rate. METHODS/DESIGN: Multi-centre study with prospective follow-up in five regions in Spain (Galicia, Balearic Islands, Catalonia, Aragón and Valencia) during the period 2010-2012. Incident cases are included with anatomopathological confirmation of colorectal cancer (International Classification of Diseases 9th revision codes 153-154) that formed a part of a previous study (n = 953).At the time of diagnosis, each patient was given a structured interview. Their clinical records will be reviewed during the follow-up period in order to obtain information on the explorations and tests carried out after treatment, and the progress of these patients.Symptoms-to-diagnosis interval is defined as the time calculated from the diagnosis of cancer and the first symptoms attributed to cancer. Treatment delay is defined as the time elapsed between diagnosis and treatment. In non-metastatic patients treated with curative intention, information will be obtained during the follow-up period on consultations performed in the digestive, surgery and oncology departments, as well as the endoscopies, tumour markers and imaging procedures carried out.Local recurrence, development of metastases in the follow-up, appearance of a new tumour and mortality will be included as outcome variables.Actuarial survival analysis with Kaplan-Meier curves, Cox regression and competitive risk survival analysis will be performed. DISCUSSION: This study will make it possible to verify if the different components of delay have an impact on survival rate in colon cancer and rectal cancer. In consequence, this multi-centre study will be able to detect the variability present in the follow-up of patients with colorectal cancer, and if this variability modifies the prognosis. Ideally, this study could determine which follow-up strategies are associated with a better prognosis in colorectal cancer.

[Characteristics and analysis of survival of people served in the program of home care from the basic health area of Raval Nord, Barcelona, 1993-2002]. / Características y análisis de la supervivencia de las personas atendidas en el programa de atención domiciliaria del Area Básica de Salud Raval Nord, Barcelona, 1993-2002.

BACKGROUND: Longer life expectancy has led to a progressive aging of the population and to growing sociosanitary homecare. This study is aimed at describing the population of patients suffering from chronic diseases having been provided with homecare throughout the first ten years that homecare was available by a primary care team at an urban Healthcare Center, to study how often this type of care was used and to analyze the survival of those individuals having been provided with this care. METHODS: A descriptive study. The subjects under study were 1,357 chronically-ill patients included from the very start of a homecare program (May 1994-December 2002). Firstly, a descriptive analysis was made the main characteristics of this population. Afterward, using Cox's proportional hazards model, the factors linked to survival were assessed, as well as having plotted the corresponding cumulative survival probability curves using the Kaplan-Meier method. RESULTS: Predominant female population (68%), and an average age of 82 (DE: 11 years). Worth of special note were the lack of elevators (76%) and loneliness (18%). Eleven percent (11%) of the patients were totally dependent for all of their daily living activities, whilst approximately 20% revealed severe cognitive disorders. With regard to the homecare, the program target of 2-3 visits/patient/year for the medical staff and off 4-6 visits/patient/year for the nursing staff were surpassed. The flu vaccine injections were always above the 70% target, whilst the tetanus vaccine injections increased yearly. CONCLUSIONS: The population cared for under this program is characterized by being greatly aged, with a high death rate and requiring continuous homecare. During the ten years studied, most of the objectives previously set were achieved.

Características y análisis de la supervivencia de las personasatendidas en el programa de atención domiciliaria del áreabásica de salud raval nord, barcelona, 1993-2002 / Characteristics and analysis of the survival of individuals cared for under the homecare program in the Raval Nord health area in Barcelona, Spain.1993-2002

Fundamentos: El aumento de la esperanza de vida ha conducido a un progresivo envejecimiento de la población y a una creciente atención sóciosanitaria a domicilio. El objetivo del presente estudio es describir la población de enfermos crónicos domiciliarios atendidos durante los 10 primeros años de atención domiciliaria por un equipo de atención primaria de un Centro de Salud urbano, estudiar la frecuentación y analizar la supervivencia de las personas atendidas en el mismo.Métodos: Estudio descriptivo. Los sujetos de estudio fueron los 1.357 enfermos crónicos incluidos desde el inicio de un programa de atención domiciliaria (mayo 94-diciembre 2002). En primer lugar se realizó un análisis descriptivo de las características principales de esta población. Posteriormente, mediante el método de los riesgos proporcionales de Cox, se valoraron los factores asociados con la supervivencia, y asimismo se elaboraron las correspondientes curvas de probabilidad de supervivencia acumulada utilizando el método de Kaplan-Meier.Resultados: Predominio de población femenina (68 por ciento), y una media de edad de 82 años (DE: 11 años). Destacan la falta de ascensores (76 por ciento), y la soledad (18 por ciento). Presentan dependencia absoluta para todas las actividades de la vida diaria un 11 por ciento de los enfermos, mientras que aproximadamente un 20 por ciento muestra severas alteraciones cognitivas. En relación con la atención domiciliaria, se superó el objetivo del programa de 2-3 visitas/enfermo/año para el personal médico y de 4-6 para el personal de enfermería. La vacunación antigripal se mantuvo siempre por encima del objetivo del 70 por ciento, mientras que la vacunación antitetánica aumentó anualmente. Conclusiones: La población atendida en este programa se caracteriza por ser muy envejecida, con una alta mortalidad y que requiere atención domiciliaria continuada. Durante los 10 años estudiados se han logrado la mayor parte de los objetivos prefijados (AU)