Reduction in the diagnostic interval after the introduction of cancer patient pathways for colorectal cancer in northern Sweden.

OBJECTIVE: To compare the diagnostic interval for patients with colorectal cancer before and after the introduction of cancer patient pathways in northern Sweden. DESIGN: A retrospective study comparing two cohorts (2012 and 2018) of patients diagnosed with colorectal cancer before and after the introduction of cancer patient pathways in 2016. SETTING: Three counties in northern Sweden with large sparsely populated areas and some cities (637143 residents ∼5.1 residents/km2). SUBJECTS: Patients were included from the Swedish Cancer Register. Electronic health records reviews were performed and linked to socioeconomic data from Statistics Sweden. MAIN OUTCOME MEASURES: Differences in the diagnostic intervals, the patient intervals and the characteristics associated with the longest diagnostic intervals and investigations starting at the emergency department. RESULTS: The two cohorts included 411 patients in 2012 and 445 patients in 2018. The median diagnostic interval was reduced from 47 days (IQI 18-99) to 29 days (IQI 9-74) (p < 0.001) after the introduction of cancer patient pathways in general. Though for the cases of cancer in the right-side (ascended) colon, the reduction of the diagnostic interval was not observed and it remained associated with investigations starting at the emergency department. CONCLUSION: Our results indicate that cancer patient pathways contributed to an improvement in the diagnostic interval for patients with colorectal cancer in general, yet not for patients with cancer in the right-side colon. IMPLICATION: In general, cancer patient pathways seem to reduce the diagnostic interval for colorectal cancer but it is not a sufficient solution for all colorectal cancer localisations.

Diagnostic interval for colorectal cancer reduced in general, particularly for patients seeking primary healthcare, after the introduction of cancer patient pathways.Patients with cancer in right-side colon still have long diagnostic intervals and mainly start their investigation through the emergency department.

Prevalence of Obesity and Malnutrition in Four Cohorts of Very Old Adults, 2000-2017.

OBJECTIVES: Investigate trends in the prevalence of obesity and malnutrition among very old adults (age ≥ 85 years) between 2000 and 2017. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: A study with data from the Umeå 85+/Gerontological regional database population-based cohort study of very old adults in northern Sweden. Every 5 years from 2000-2002 to 2015-2017, comprehensive assessments of participants were performed during home visits (N=1602). Body mass index (BMI) classified participants as underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). Mini Nutritional Assessment (MNA) scores classified participants as malnourished (0 to <17), at risk of malnutrition (17-23.5), and having good nutritional status (24-30). Prevalence and trends were examined using analysis of variance and chi-squared tests, including subgroup analyses of nursing home residents. RESULTS: Between 2000-2002 and 2015-2017, the mean BMI increased from 24.8± 4.7 to 26.0± 4.7 kg/m2. The prevalence of obesity and underweight were 13.4% and 7.6%, respectively, in 2000-2002 and 18.3% and 3.0%, respectively, in 2015-2017. The mean MNA score increased between 2000-2002 and 2010-2012 (from 23.2± 4.7 to 24.2± 3.6), and had decreased (to 23.3± 4.2) by 2015-2017. The prevalence of malnutrition was 12.2%, 5.1%, and 8.7% in 2000-2002, 2010-2012, and 2015-2017, respectively. Subgroup analyses revealed similar BMI and MNA score patterns among nursing home residents. CONCLUSIONS: Among very old adults, the mean BMI and prevalence of obesity seemed to increase between 2000-2002 and 2015-2017. Meanwhile, the nutritional status (according to MNA scores) seemed to improve between 2000-2002 and 2010-2012, it declined by 2015-2017.

Body mass index, Mini Nutritional Assessment, and their association with five-year mortality in very old people.

OBJECTIVES: to investigate the prevalence of malnutrition and the association between Body Mass Index (BMI), Mini Nutritional Assessment (MNA) and five-year mortality in a representative population of very old (>85 years) people. DESIGN: A prospective cohort study. SETTING: A population-based study of very old people in northern Sweden and western Finland, living in institutional care or in the community. PARTICIPANTS: Out of 1195 potential participants, 832 were included (mean age 90.2±4.6 years). MEASUREMENTS: Nutritional status was assessed using BMI and MNA and the association of those two variables with five-year mortality was analyzed. RESULTS: The mean BMI value for the whole population was 25.1±4.5 kg/m2, with no difference between genders (P=0.938). The mean MNA score was 22.5±4.6 for the whole sample, and it was lower for women than for men (P<0.001). Thirteen percent were malnourished (MNA<17) and 40.3% at risk of malnutrition (MNA 17-23.5) according to MNA. Also, 34.8% of those with a MNA score <17 still had a BMI value ≥22.2 kg/m2. A BMI value <22.2 kg/m2 and a MNA score<17 were associated with lower survival. The association with mortality seemed to be J-shaped for BMI, and linear for MNA. CONCLUSIONS: Malnutrition according to MNA was common, but a substantial portion of those with a low MNA score still had a high BMI value, and vice versa. The association with mortality appeared to be J-shaped for BMI, and linear for MNA. The MNA seems to be a good measurement of malnutrition in very old people, and BMI might be misleading and could underestimate the prevalence of malnutrition, especially in women.