The proposed taxonomy will help us gain a more nuanced understanding of older cancer patients' clinical presentation and may lead to a more accurate identification of older patients who might benefit from standard cancer treatment, and those who might experience adverse outcomes.

BACKGROUND-Little is known about the contribution of older patients' complexity of care needs (COCN) to unstaged cancer, or incomplete evaluation of the extent of disease. We aimed at examining the association between the patients' COCN at baseline and unstaged cancer.

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Background There are currently no Medicare claims-based algorithms to identify patients receiving nursing home care (NHC). This constitutes an important limitation in outcome studies using population-based data. Objectives To assess the ability of claims data to identify patients receiving NHC, using the nursing home Minimum Data Set (MDS) as the gold standard. We hypothesized that physician claims carrying relevant Evaluation and Management (E&M) procedure codes would be an adequate source to identify nursing home patients. Research Design Cross-sectional study using the Ohio Cancer-Aging Linked Database, developed by linking records from the Ohio Cancer Incidence Surveillance System with multiple sources of data, including Medicare enrollment and claims files, and the MDS. Subjects Patients 65 years of age or older residing in Ohio, and diagnosed with incident breast, prostate, or colorectal cancer during years 1997–2001. We limited our study cohort to fee-for-service patients receiving NHC during calendar year 2002, with a look-back period in the claims data to November 2001. Measures Sensitivity and positive predictive value (PPV). Results Sensitivity, or the proportion of patients identified through the MDS file who were also successfully identified through the claims data was 88.1%. PPV, or the proportion of patients with the relevant E&M codes who were also identified in the MDS file was 83.9%. Conclusions Carrier files may be an acceptable data source to identify nursing home patients, paving the way for future risk adjustment techniques to account for nursing home status.

The implementation of the PPS in nursing homes has been associated with a decrease in the amount of rehabilitation services, targeted at those predicted to receive higher amounts and an increased frequency of providing services targeted at those predicted to be less likely to receive them. The outcomes of the changes deserve further study.

INTRODUCTION Improving patient pathways of care is becoming increasingly important in the delivery of timely, appropriate surgical care. With this aim, we analysed the referral and management pathway of patients undergoing diagnostic superficial lymph node biopsy.PATIENTS AND METHODS A retrospective review of case notes of patients undergoing diagnostic superficial lymph node biopsy over 3 years, 1998-2000 at the Bradford Hospitals NHS Trust. Indication for surgical biopsy was based on clinical suspicion following assessment in the out-patient clinic for the majority, and arrangement of investigations as deemed appropriate. There were no clinical algorithms in use during the study period.RESULTS There was no evidence for the use of explicit protocols for referral or management. Biopsy was often delayed. Of 268 patients referred from primary care, referral was made to any of 14 hospital departments with 39% (105 of 268) attending more than one outpatient appointment, and 155 (41 of 268) attending more than one department. Eighteen percent (47 of 268) of patients were informed of their diagnosis within 6 weeks of referral and 42% (113 of 268) within 3 months of referral. Nine percent (24 of 268) underwent pre-operative fine needle aspiration cytology. Of patients with enlarged neck nodes, 29% (52/180) had examination of the upper aero-digestive tract.CONCLUSIONS The study supports the introduction of co-ordinated problem-based referral and management pathways for the management of patients with enlarged superficial lymph nodes supported by regular audits of practice.

A 12‐year retrospective view of patients admitted to the rehabilitation unit for care of spinal cord injury (SCI) secondary to neoplasia was conducted. Twenty‐seven such patients were identified. One year survival was 58%, and independent functioning achieved in the rehabilitation unit was well‐maintained in the survivors. Survival and functional outcome tended to be best in those with less severe neurologic injuries. The study indicated a better 1‐year survival in such injuries than has previously been described. Patients with complete SCI had a relatively poor prognosis, especially for independent function. As control of metastatic cancer improves, patients with spinal cord injury caused by neoplasia will probably become a significant part of the SCI population.

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