RESUMEN
BACKGROUND: Colorectal cancer with synchronous liver-only metastasis is managed with a multimodal approach, however, optimal sequencing of modalities remains unclear. METHODS: A retrospective review of all consecutive rectal or colon cancer cases with synchronous liver-only metastasis was conducted from the South Australian Colorectal Cancer Registry from 2006 to 2021. This study aimed to investigate how order and type of treatment modality affects overall survival. RESULTS: Data of over 5000 cases were analysed (n = 5244), 1420 cases had liver-only metastasis. There were a greater number of colon than rectal primaries (N = 1056 versus 364). Colonic resection was the preferred initial treatment for the colon cohort (60%). In the rectal cohort, 30% had upfront resection followed by 27% that had chemo-radiotherapy as 1st line therapy. For the colon cohort, there was an improved 5-year survival with surgical resection as initial treatment compared to chemotherapy (25% versus 9%, P < 0.001). In the rectal cohort, chemo-radiotherapy as the initial treatment was associated with an improved 5-year survival compared to surgery or chemotherapy (40% versus 26% versus 19%, P = 0.0015). Patients who were able to have liver resection had improved survival, with 50% surviving over 5 years compared to 12 months in the non-resected group (P < 0.001). Primary rectal KRAS wildtype patients who underwent liver resection and received Cetuximab had significantly worse outcomes compared to KRAS wildtype patients who did not (P = 0.0007). CONCLUSIONS: Where surgery is possible, resection of liver metastasis and primary tumour improved overall survival. Further research is required on the use of targeted treatments in patients undergoing liver resection.
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Neoplasias del Colon , Neoplasias Colorrectales , Neoplasias Hepáticas , Humanos , Proteínas Proto-Oncogénicas p21(ras) , Resultado del Tratamiento , Australia/epidemiología , Neoplasias Hepáticas/cirugía , Hepatectomía , Neoplasias del Colon/cirugía , Estudios Retrospectivos , Neoplasias Colorrectales/patologíaRESUMEN
BACKGROUND: Effective targeting of RAS mutations has proven elusive until recently. Novel agents directly targeting KRAS G12C have shown promise in early-phase clinical trials that included patients with metastatic colorectal cancer. Prior reports have suggested that G12C mutation may be predictive of poor outcome. OBJECTIVE: Assessment of the specific characteristics and prognostic implications of individual RAS mutation subtypes in patients with metastatic colorectal cancer. PATIENTS AND METHODS: Retrospective review of individual RAS mutation types from the South Australian Metastatic Colorectal Registry between 2006 and 2020. RESULTS: Of the 5165 patients entered onto the registry, 2305 (45%) had RAS mutation results available. 772 (33%) had a RAS mutation. The nature of the RAS mutation was available in 668 (87% of those with RAS mutation). Rare mutations (outside codons 12 and 13) made up 12.6% of the total. There were numerical differences in survival between the specific RAS mutation subgroups, with the longest median overall survival (30 months) observed in those with G12S mutations. However, there was no statistical difference in survival when comparing the various RAS mutations, including the comparison of G12C to G12S (p = 0.38). Patients with cancer harbouring rare RAS mutations had a median survival of 30 months. CONCLUSIONS: Whilst the G12S mutation was associated with the longest survival numerically, the observed survival for patients with the most common RAS mutations (G12C, G12V, G12A, G12D and G13D) did not significantly differ.
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Neoplasias Colorrectales , Proteínas ras , Australia , Neoplasias Colorrectales/tratamiento farmacológico , Humanos , Mutación , Pronóstico , Proteínas Proto-Oncogénicas p21(ras)/genética , Sistema de Registros , Australia del Sur , Proteínas ras/genéticaRESUMEN
AIM: Reviewing outcomes of regorafenib use in metastatic colorectal cancer using real-world data from the South Australian Metastatic Colorectal Cancer Registry. METHODS: A retrospective review of the characteristics and outcomes of patients who received regorafenib in the Registry up to December 2018. The registry started in February 2006. RESULTS: Fifty-three patients received regorafenib therapy since approved by the therapeutic goods administration in November 2013. The median age was 66 (range 34-82). 66% were male, 66% had stage IV disease at diagnosis, 53% had liver only involvement, whereas 13% had liver and lung disease and 6% had lung only involvement. 75% had left-sided primary. KRAS was available in 35/53 patients with 49% of them being WT. BRAF status was known in 8/53 with 25% of them having a mutated variant. MSI testing was known in 14 patients in whom 21% of them had MSI-High tumors. Prior lines of treatment received: one line 4%, two 9%, three 23%, four 26%, >four 37%. Prior biological use: bevacizumab 72%, anti-EGFR 100% (for RAS WT). Median survival from diagnosis was 3.3 years (95% CI, 2.8-3.8 years). Median survival from the start of regorafenib was 7.1 months (95% CI, 4.8-9.4 months) and the 12-month survival rate was 28%. CONCLUSION: The survival outcome for those patients from our population-based registry who access regorafenib is in keeping with reports from large, randomized trials. Thus, clinicians can quote local real world data when discussing efficacy and access to regorafenib therapy for mCRC patients.
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Neoplasias del Colon , Neoplasias Colorrectales , Neoplasias del Recto , Anciano , Australia/epidemiología , Neoplasias del Colon/tratamiento farmacológico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/genética , Femenino , Humanos , Masculino , Compuestos de Fenilurea/uso terapéutico , Piridinas , Neoplasias del Recto/tratamiento farmacológico , Sistema de Registros , Australia del Sur/epidemiologíaRESUMEN
BACKGROUND: Studies have reported significant differences in baseline characteristics and outcomes of metastatic colorectal cancer (mCRC) patients when managed in private versus public hospitals. AIMS: To compare disease, treatment and survival outcomes of patients with mCRC in public versus private hospitals in South Australia (SA). METHODS: Analysis of prospectively collected data from the SA mCRC Registry. Patterns of care and outcome data according to location of care and socioeconomic status based on Index of Relative Socio-Economic Advantage and Disadvantage were analysed. RESULTS: A total of 3470 patients' data was analysed during February 2006-January 2015. The majority (70%) of patients received treatment in public hospitals. Patients in the upper 50% for Index of Relative Socio-Economic Advantage and Disadvantage score were more likely to receive treatment at a private hospital (41.2% vs 21.56%) compared to <50%. Public patients had higher burden of disease (10.49% vs 7.41%, P = 0.005). Public patients received less treatment compared to the private patients (odds ratio = 0.48 (0.38-0.61), P = 0.01) and rates of surgical resections were lower in public patients. After adjusting for the covariates, public patients survive 1.33 months (P = 0.025) shorter than private patients with follow-up time of 5 years. Patients receiving metastasectomy and more than three lines of treatment were shown to have the greatest survival benefit. CONCLUSION: Public patients have a higher burden of disease and in comparison are less likely to receive systemic therapy and have lower survival than patients treated in private hospitals.
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Neoplasias Colorrectales , Australia , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/terapia , Hospitales Privados , Hospitales Públicos , Humanos , Sistema de Registros , Australia del Sur/epidemiología , Resultado del TratamientoRESUMEN
BACKGROUND: Anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (cetuximab or panitumumab) are today increasingly used in the first- or second-line setting for RAS wild-type metastatic colorectal cancer (CRC) patients. Following progression beyond third- or fourth-line therapy, some patients are unsuitable for further chemotherapy because of poor performance status or patient choice. However, a significant number of patients are still candidates for further therapy despite limited standard options being available. The role of rechallenge with anti-EGFR therapy, particularly in patients who had previously responded, is often considered, but there is limited evidence in the literature to support such a strategy. OBJECTIVE: This retrospective study aims to review the outcome of metastatic CRC patients who had anti-EGFR rechallenge. PATIENTS AND METHODS: Patients who had been rechallenged with anti-EGFR therapy were identified from the South Australian metastatic CRC database. Patient characteristics were recorded and tumor response was retrospectively assessed using Response Evaluation Criteria in Solid Tumors (RECIST). Kaplan-Meier analysis was used to assess progression free survival (PFS) for each rechallenge and overall survival (OS). RESULTS: Twenty-two patients were eligible for inclusion in this analysis. Disease control rate (stable disease and partial response) was 45.4% (ten patients) for patients who received rechallenge anti-EGFR. Seven patients received a second rechallenge and disease control rate was 28.6% (two patients). The median interval time between initial anti-EGFR therapy and rechallenge was 13.5 months. The median PFS after rechallenge 1 was 4.1 months and after rechallenge 2 was 3.5 months. The median OS was 7.7 months from date of rechallenge. CONCLUSIONS: Anti-EGFR rechallenge provides clinical benefit in patients with RAS wild-type metastatic CRC.
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Anticuerpos Monoclonales/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales/farmacología , Neoplasias Colorrectales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Sistema de Registros , Estudios Retrospectivos , Australia del SurRESUMEN
BACKGROUND: Microsatellite instability (MSI) is the molecular marker for DNA mismatch repair deficiency (dMMR) in colorectal cancer (CRC) and has been associated with better survival outcomes in early stage disease. In metastatic CRC (mCRC), outcomes for patients with MSI are less clear. There is evolving evidence that treatment pathways for MSI CRC should include programmed-death 1 (PD-1) antibodies. OBJECTIVE: An analysis was performed to explore the impact of MSI status on overall survival (OS) in mCRC. PATIENTS AND METHODS: South Australian Metastatic CRC Registry data were analysed to assess patient characteristics and survival outcomes, comparing patients with MSI CRC with those whose tumours were microsatellite stable (MSS). Kaplan-Meier survival analysis was used to assess OS. Cox regression analysis was undertaken to assess the independence of MSI as a prognostic factor. RESULTS: Of 4359 patients registered on the database, 598 (14%) had been tested for, and 62 (10.1%) of these patients had, demonstrable MSI. There were significantly higher rates of right-sided primary (p < 0.001), poorly differentiated pathology (p = 0.002), and BRAF V600E mutation (p < 0.001) in the MSI group. The MSI group were also less likely to receive chemotherapy (p < 0.001) or to have liver surgery, but more likely to be diagnosed at an early stage. The median overall survival was 9.5 months for those with MSI CRC versus 21.3 months for MSS CRC patients (p = 0.052). Cox regression analysis indicated that MSI was not an independent predictor of OS. Independent predictors of better OS included having liver surgery for metastasis, having chemotherapy, and being initially diagnosed at an early stage. CONCLUSIONS: Only 14% of patients with mCRC were tested for MSI, and 1 in 10 were found to be MSI high. The clinical characteristics of MSI mCRC are in keeping with those previously reported. MSI in this population-based registry was associated with a numerically lower survival which did not attain statistical significance.
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Neoplasias Colorrectales/mortalidad , Cirugía Colorrectal/mortalidad , Neoplasias Hepáticas/mortalidad , Inestabilidad de Microsatélites , Sistema de Registros/estadística & datos numéricos , Anciano , Australia , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: Pattern of spread in patients with metastatic colorectal cancer (mCRC) is variable and may reflect different biology in subsets of patients. This is a retrospective study to explore the outcome of patients with mCRC based on their site of metastasis at diagnosis and to explore the association between tumor characteristics [KRAS/RAS, BRAF, mismatch repair (MMR) status, site of primary] and the site of metastasis. METHODS: Patients from two Australian databases were divided into six groups based on site of metastasis at time of diagnosis of metastatic disease; lung-only, liver-only, lymph node-only or any patients with brain, bone or peritoneal metastases. Primary endpoint was overall survival (OS) of each cohort compared with the rest of the population. A Mantel-Haenszel chi-squared test used to explore the association between site of metastasis and selected tumor characteristics. RESULTS: Five thousand nine hundred and sixty-seven patients were included. In a univariate analysis, median OS was significantly higher when metastases were limited to lung or liver and shorter for those with brain, bone or peritoneal metastases (p < .001) in both datasets. BRAF mutation was strongly associated with peritoneal metastases (relative risk = 1.8, p < .001) with lower incidence of lung (RR = 0.3, p = .004) and liver (RR = 0.7, p = .005) limited metastases. Lung-only metastases were more frequent with KRAS/RAS mutation (RR = 1.4, p = .007). Left colon tumors were associated with bone (RR = 1.6, p < .001) and lung-only metastases (RR = 2.3, p = .001) while peritoneal spread was less frequent compared with right colon tumors (RR = 0.6, p < .001). Rectal cancer was associated with brain, bone and lung metastases (RR = 1.7; p = .002, 1.7; p < .001, 2.0; p < .001). Liver-only metastases were less frequent in deficient MMR tumors (RR = 0.7, p = .01). CONCLUSION: Survival duration with mCRC is related to the site of metastases with lung limited disease showing a more favorable survival outcome compared to other single metastatic site disease. The BRAF mutation and primary rectal cancer were associated with poor prognostic metastatic sites.
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Biomarcadores de Tumor/genética , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas p21(ras)/genética , Anciano , Neoplasias Encefálicas/secundario , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/genética , Reparación de la Incompatibilidad de ADN/genética , Bases de Datos Factuales , Femenino , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/secundario , Masculino , Mutación , Neoplasias Peritoneales/genética , Neoplasias Peritoneales/secundario , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND: The aim of the current study was to assess outcomes following liver resection in metastatic CRC (mCRC) in South Australia across two study periods (pre-2006 versus post-2006). METHODS: The South Australian (SA) Clinical Registry for mCRC maintains data prospectively on all patients in SA with mCRC diagnosed from 01 February 2006. This data was linked with a prospectively collated database on liver resections for mCRC from 01/01/1992 to 01/02/2006. The primary end point was overall survival. RESULTS: 757 patients underwent liver resection for mCRC. Liver resection was performed on 286 patients pre-2006 and 471 patients post-2006. The median age of the study population was 62 years, and this was similar across both eras. Overall survival was significantly better in the post-2006 era (hazard ratio HR = 0.45, p = 0.001). Complications (59% pre-2006 versus 23% post-2006) and transfusion rates (34% pre-2006 versus 2% post-2006) were significantly higher in the pre-2006 era. Repeat liver resection rates were significantly higher in the post-2006 era (1% pre-2006 versus 10% post-2006). CONCLUSIONS: Outcomes following liver resection for mCRC have improved over time, with significantly better overall survival in the post-2006 era compared to pre-2006.
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Neoplasias Colorrectales/patología , Hepatectomía , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Colorrectales/mortalidad , Bases de Datos Factuales , Femenino , Hepatectomía/efectos adversos , Hepatectomía/mortalidad , Hepatectomía/tendencias , Humanos , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Factores de Riesgo , Australia del Sur , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine how well the Mini Nutritional Assessment (MNA) Short Form (MNA-SF) performed as a nutritional screening tool when calf circumference replaced body mass index (BMI) as the included anthropometric measurement. METHODS: A total of 100 patients ≥70 years were recruited from a Geriatric Evaluation and Management Unit. RESULTS: Mean age of patients was 85.2 (6.1) years. By the full MNA, 40% of patients were malnourished. The MNA correlated highly with both of its short-form versions (r = 0.87 and r = 0.90 for the BMI and calf circumference versions, respectively). Both MNA-SF versions also showed high accuracy in identifying malnutrition (auROC values >0.89). CONCLUSIONS: The MNA-SF is a rapid and accurate way to screen for malnutrition in hospitalised older adults. Substitution of BMI measurement with the time-efficient calf circumference measurement maintained MNA-SF accuracy. It is recommended that calf circumference measurement be used for nutritional screening by MNA-SF in a hospital setting.
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Desnutrición/diagnóstico , Evaluación Nutricional , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Femenino , Hospitalización , Humanos , MasculinoRESUMEN
OBJECTIVE: Brain metastasis is considered rare in metastatic colorectal cancer (mCRC); thus, surveillance imaging does not routinely include the brain. The reported incidence of brain metastases ranges from 0.6% to 3.2%. METHODS: The South Australian mCRC Registry (SAmCRC) was analyzed to assess the number of patients presenting with brain metastasis during their lifetime. Due to small numbers, a descriptive analysis is presented. RESULTS: Only 59 patients of 4,100 on the registry at the time of analysis had developed brain metastasis (1.4%). The clinical characteristics of those with brain metastasis were as follows: the median age was 65.3 years and 51% were female. Where the V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation status of the tumor was known, the majority harbored a KRAS mutation (55%); 31 (53%) underwent craniotomy and 55 (93%) underwent whole-brain radiotherapy. The median survival time from diagnosis of brain metastasis was 4.2 months (95% confidence interval 2.9-5.5). Patients who underwent craniotomy and radiotherapy had superior survival compared to those who underwent whole-brain radiotherapy (8.5 months vs. 2.2 months, respectively). Data from the SAmCRC (a population-based registry) confirm that brain metastases are rare and the median time to development is approximately 2 years. CONCLUSIONS: Brain metastasis is a rare outcome in advanced CRC. Patients within the registry tended to be female, young in age, and harbored with higher rates of KRAS mutations. Whether routine surveillance brain scanning should be considered remains controversial given the relative rarity of developing brain metastases in mCRC and ultimately, most patients with central nervous system involvement die from their extracranial disease.
RESUMEN
BACKGROUND: To determine the extent to which variations in monthly Mental Health Emergency Department (MHED) presentations in South Australian Public Hospitals are associated with the Australian Bureau of Statistics (ABS) monthly unemployment rates. METHODS: Times series modelling of relationships between monthly MHED presentations to South Australian Public Hospitals derived from the Integrated South Australian Activity Collection (ISAAC) data base and the ABS monthly unemployment rates in South Australia between January 2004-June 2011. RESULTS: Time series modelling using monthly unemployment rates from ABS as a predictor variable explains 69% of the variation in monthly MHED presentations across public hospitals in South Australia. Thirty-two percent of the variation in current month's male MHED presentations can be predicted by using the 2 months' prior male unemployment rate. Over 63% of the variation in monthly female MHED presentations can be predicted by either male or female prior monthly unemployment rates. CONCLUSIONS: The findings of this study highlight that even with the relatively favourable economic conditions, small shifts in monthly unemployment rates can predict variations in monthly MHED presentations, particularly for women. Monthly ABS unemployment rates may be a useful metric for predicting demand for emergency mental health services.
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Servicios de Urgencia Psiquiátrica/estadística & datos numéricos , Trastornos Mentales/etiología , Desempleo/tendencias , Servicios de Urgencia Psiquiátrica/tendencias , Femenino , Hospitales Públicos/estadística & datos numéricos , Hospitales Públicos/tendencias , Humanos , Masculino , Trastornos Mentales/epidemiología , Modelos Estadísticos , Factores de Riesgo , Estaciones del Año , Factores Sexuales , Australia del Sur/epidemiología , Desempleo/estadística & datos numéricosRESUMEN
BACKGROUND: The difficulty of recruiting older people to clinical trials is well described, but there is limited information about effective ways to screen and recruit older people into trials, and the reasons for their reluctance to enrol. This paper examines recruitment efforts for a community-based health intervention study that targeted older adults. METHODS: One year randomized control trial. Undernourished men and women, aged ≥ 65 years and living independently in the community were recruited in three Australian states. Participants were allocated to either oral testosterone undecanoate and high calorie oral nutritional supplement or placebo medication and low calorie oral nutritional supplementation. Hospital admissions, functional status, nutritional health, muscle strength, and other variables were assessed. RESULTS: 4023 potential participants were identified and 767 were screened by a variety of methods: hospital note screening, referrals from geriatric health services, advertising and media segments/appearances. 53 participants (7% of total screened) were recruited. The majority of potentially eligible participants declined participation in the trial after reading the information sheet. Media was the more successful method of recruiting, whereas contacting people identified by screening a large number of hospital records was not successful in recruiting any participants. CONCLUSION: Recruitment of frail and older participants is difficult and multiple strategies are required to facilitate participation. TRIAL REGISTRATION: Australian Clinical Trial Registry: ACTRN 12610000356066 date registered 4/5/2010.
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Andrógenos/administración & dosificación , Suplementos Dietéticos , Desnutrición/dietoterapia , Participación del Paciente/estadística & datos numéricos , Selección de Paciente , Testosterona/análogos & derivados , Anciano , Anciano de 80 o más Años , Australia , Dieta/métodos , Femenino , Anciano Frágil , Servicios de Salud para Ancianos , Hospitalización , Humanos , Vida Independiente , Masculino , Desnutrición/fisiopatología , Fuerza Muscular/efectos de los fármacos , Participación del Paciente/psicología , Testosterona/administración & dosificaciónRESUMEN
AIM: To examine the association of nutritional screening tools (NSTs) and anthropometric measures with hospital outcomes in older people. METHODS: In 172 patients aged ≥70 years admitted to a Geriatric Evaluation Management Unit (GEMU), nutritional status was measured using the Mini-Nutritional Assessment (MNA), MNA-short form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Simplified Nutritional Appetite Questionnaire, calf circumference (CC), mid-arm circumference (MAC) and BMI. RESULTS: Malnutrition according to the MNA occurred in 53 (31%) patients. Functional change was associated with GNRI (Beta coefficient (ß), 95% CIâ = 0.17, 0.001-0.33) and CC (ß, 95% CIâ = 0.17, 0.01-0.33); GEMU length of stay was associated with MNA-SF-BMI (ß, 95% CIâ = -0.02, -0.003 to -0.004) and MNA-SF-CC (ß, 95% CIâ = -0.02, -0.003 to -0.001). MAC was associated with discharge to higher level of care (OR, 95% CIâ = 0.88, 0.81-0.96). CONCLUSION: In hospitalised older people, admission NSTs and anthropometric measures associate with discharge outcomes.
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Antropometría , Evaluación Geriátrica/métodos , Desnutrición/diagnóstico , Evaluación Nutricional , Estado Nutricional , Alta del Paciente , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Femenino , Humanos , Tiempo de Internación , Modelos Logísticos , Masculino , Desnutrición/fisiopatología , Oportunidad Relativa , Valor Predictivo de las Pruebas , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Malnutrition is a major problem in hospitalised older people. Many nutrition screening tools are available for malnutrition identification, however little is known about their prognostic ability. This prospective, observational study investigated the prognostic value of three nutritional screening tools in a Geriatric Evaluation and Management Unit: the Geriatric Nutritional Risk Index (GNRI), the Mini Nutritional Assessment (MNA) and the Mini Nutritional Assessment short form (MNA-SF), incorporating either body mass index or calf circumference. Poor six- month outcome was defined as new admission to higher level residential care or mortality at six months post-discharge. Predictive ability of poor outcome was assessed by logistic regression models, adjusting for age, gender, cognition and co-morbidity. Predictive accuracy was determined by area under Receiver Operator Characteristic curves, sensitivity, specificity, predictive values and Youden Index. One hundred and seventy-two consecutive patients with a mean (SD) age=85.2 (6.4) years were included in the study. Malnutrition was identified in 31% of patients using the MNA and was associated with a higher risk of poor six-month outcome when identified by the MNA (OR, 95% CI=3.29, 1.17-9.23) and the GNRI (OR, 95% CI=2.84, 1.31-6.19), but not by the MNA-SF. All screening tools lacked discriminative power for outcome prediction. The MNA and GNRI were useful clinical predictors of poor six-month outcome, although their accuracy of prediction was low. Nutritional screening remains a priority in the routine assessment of hospitalised older people.
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Evaluación Geriátrica/métodos , Hospitalización/estadística & datos numéricos , Desnutrición/diagnóstico , Desnutrición/epidemiología , Evaluación Nutricional , Evaluación del Resultado de la Atención al Paciente , Anciano de 80 o más Años , Índice de Masa Corporal , Pesos y Medidas Corporales/métodos , Pesos y Medidas Corporales/estadística & datos numéricos , Femenino , Evaluación Geriátrica/estadística & datos numéricos , Hogares para Ancianos/estadística & datos numéricos , Humanos , Pierna , Estudios Longitudinales , Masculino , Casas de Salud/estadística & datos numéricos , Estado Nutricional/fisiología , Oportunidad Relativa , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Curva ROC , Reproducibilidad de los Resultados , Riesgo , Sensibilidad y Especificidad , Australia del Sur/epidemiologíaRESUMEN
BACKGROUND: admission to a Geriatric Evaluation and Management Unit (GEMU) can optimise a patient's chance of functional recovery. OBJECTIVE: to evaluate the ability of several commonly used frailty and functional decline indices to predict GEMU outcomes, both at discharge and at 6 months. DESIGN: prospective, observational study. SETTING AND PARTICIPANTS: consecutive GEMU patients aged ≥70 years. METHODS: patients were classified as 'frail' or 'at high risk of functional decline' using several frailty and functional decline instruments. Predictive ability was evaulated using logistic regression and area under receiver operator characteristic (ROC) curves (auROC). RESULTS: a total of 172 patients were included. Frailty prevalence varied from 24 to 94% depending on the instrument used. Several instruments predicted patients at risk of poor outcome, including the Frailty Index of Accumulative Deficits (FI-CD), Fried's Cardiovascular Health Study index, the Study of Osteoporotic Fractures index, an adapted Katz score of activities of daily living (ADL), Instrumental ADL, the Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie (SHERPA) and grip strength [odds ratio (OR) range of 2.06-6.47]. Adequate discriminatory power for discharge outcome was achieved by the FI-CD (auROC = 0.735, P < 0.001) and an adapted Katz score (auROC = 0.704, P = < 0.001). The FI-CD also showed adequate discriminatory power for a poor 6-month outcome (auROC = 0.702, P < 0.001). CONCLUSION: frailty and functional decline instruments can predict older patients at risk of poor outcome. However, only the FI-CD showed adequate discriminatory power for outcome prediction at both follow-up time-points.
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Anciano Frágil , Evaluación Geriátrica/métodos , Pacientes Internos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Modelos Logísticos , Masculino , Estudios Observacionales como Asunto , Pronóstico , Estudios Prospectivos , Curva ROC , Tasa de SupervivenciaRESUMEN
OBJECTIVE: To determine if functional health literacy (FHL) mediates the relationship between socio-economic status, and perception of the risk of lifestyle behaviors for cancer. METHODS: Cross-sectional, random population survey, 2824 people aged ≥15 years, September-October 2008, included newest vital sign measure of FHL. RESULTS: Less than adequate FHL occurred in 45.1%. People who perceived behavioral factors (smoking, diet, obesity, alcohol, physical activity) to be not important, or did not know if they were important cancer risks, were more likely to have inadequate FHL. In a logistic regression model adjusted for age, gender, education, income, occupation, country of birth and area of residence, inadequate FHL was associated with 2-3 (OR=1.9; 95% CI: 1.2-3.0) and 4 or more self-reported lifestyle risk factors (OR=2.8; 95% CI: 1.6-5.0). In a structural equation model of the relationship of socio-economic status, perceptions of risk and behaviors there was significant mediation effect of FHL on the path from SES to health perceptions, estimated 29.4% of the total effect. CONCLUSION: A specific focus on the literacy demands made on individuals from health promotion and materials with a view to improving health communication is indicated. PRACTICE IMPLICATIONS: Health literacy is important for health promotion.