No abstract

BACKGROUND: Currently, there is very low-quality evidence available regarding benefit of surgical resection of the primary tumor (SRPT), in patients with stage IV colorectal cancer (CRC). In the absence of randomization, the reported benefit may reflect selection of younger and healthier patients with good performance status. A large population-based cohort study was undertaken to determine the survival benefit of SRPT in advanced CRC by eliminating various biases reported in the literature. METHODS: A retrospective cohort study involving patients with stage IV CRC, diagnosed between 1992 and 2005, in the province of Saskatchewan, Canada. Survival was estimated by using the Kaplan-Meier method. Survival distribution was compared by log-rank test. Cox proportional multivariate regression analysis was performed to determine survival benefit of SRPT by controlling other prognostic variables. RESULTS: A total of 1378 eligible patients were identified. Their median age was 70 years (range, 22-98 years) and male:female ratio was 1.

The Saskatchewan Farm Injury Cohort (SFIC) is a major new Canadian study that was developed to evaluate potential causes of injury among farmers and their family members. The cohort involves 2,390 farms and 5,492 farm people being followed over a two-year period. The article describes the rationale and methodology for the baseline and longitudinal components of this study. The SFIC is one of the first studies to apply population health theory to the modeling of risks for injury in a defined Canadian population. In doing so, the relative influence of several potential causes of farm injury, including physical, socioeconomic, and cultural factors, will be estimated. Study findings will inform the content and targeting of injury prevention initiatives specific to the farm occupational environment.

rate was 29.7% (95% ci: 18.5% to 41.0%), and the non-resection surgical procedures rate in the nonresection group was 27.6% (95 ci: 15.4% to 39.9%). No study provided qol data. ConclusionsAlthough this review supports primary tumour resection in advanced crc, the results have significant biases. Randomized trials are warranted to confirm the findings. KEY WORDSPrimary tumour resection, stage iv colorectal cancer, palliative surgery, survival INTRODUCTIONColorectal cancer (crc) is one of the leading causes of cancer death in North America 1 . The median overall survival of patients with stage iv crc managed with best supportive care alone is about 5-6 months 2 . Systemic therapy provides meaningful improvements in median survival and progression-free survival. Overall, with the judicious use of novel cytotoxic and biologic agents, the median overall survival of patients with stage iv crc has been extended to approximately 2 years [3][4][5] .The optimal surgical management of stage iv crc that is not amenable to curative resection is unknown. Although administration of systemic therapy in patients with stage iv crc may convert unresectable into resectable disease, the principal goal of treatment in most patients is to prolong survival, and only about 10%-15% patients are alive at 5 years. Consequently, in patients with stage iv crc, the potential morbidity of treatment and the treatment's impact on quality of life (qol) for the patient must be considered.Resection of the primary tumour in patients with stage iv cancer is often performed to deal with presenting primary tumour symptoms and ABSTRACT PurposeSurgical resection of the primary tumour in patients with advanced colorectal cancer (crc) remains controversial. This review compares survival in patients with advanced crc who underwent surgical resection of the primary tumour with that in patients not undergoing resection, and determines rates of postoperative mortality and nonfatal complications, the primary tumour complication rate, the non-resection surgical procedures rate, and quality of life (qol). MethodsReports in the central, medline, and embase databases were searched for relevant studies, which were selected using pre-specified eligibility criteria. The search was also restricted to publication dates from 1980 onward, the English language, and studies involving human subjects. Screening, evaluation of relevant articles, and data abstraction were performed in duplicate, and agreement between the abstractors was assessed. Articles that met the inclusion criteria were assessed for quality using the Newcastle-Ottawa Scale. Data were collected and synthesized per protocol. ResultsFrom among the 3379 reports located, fifteen retrospective observational studies were selected. Of the 12,416 patients in the selected studies, 8620 (69%) underwent surgery. Median survival was 15.2 months (range: 10-30.7 months) in the resection group and 11.4 months (range: 3-22 months) in the nonresection group. Hazard ratio for survival was 0.69 [95% confidence interval (ci): ...

BackgroundRespiratory disease can impose a significant burden on the health of rural populations. The Saskatchewan Rural Health Study (SRHS) is a new large prospective cohort study of ages 6 and over currently being conducted in farming and non-farming communities to evaluate potential health determinants associated with respiratory outcomes in rural populations. In this article, we describe the rationale and methodology for the adult component.The study is being conducted over 5 years (2009–15) in two phases, baseline and longitudinal. The baseline survey consists of two components, adults and children. The adult component consists of a questionnaire-based evaluation of individual and contextual factors of importance to respiratory health in two sub populations (a Farm Cohort and a Small Town Cohort) of rural families in Saskatchewan Rural Municipalities (RMs). Clinical studies of lung function and allergy tests are being conducted on selected sub-samples of the two cohorts based on the positive response to the last question on the baseline questionnaire: “Would you be willing to be contacted about having breathing and/or allergy tests at a nearby location?”. We adopted existing population health theory to evaluate individual factors, contextual factors, and principal covariates on the outcomes of chronic bronchitis, chronic obstructive pulmonary disease, asthma and obstructive sleep apnea.FindingsOf the RMs selected to participate, 32 (89%) out of 36 RMs and 15 (94%) out of 16 small towns within the RMs agreed to participate. Using the mail out survey method developed by Dillman, we obtained completed questionnaires from 4264 households (8261 individuals). We obtained lung function measurements on 1609 adults, allergy skin test information on 1615 adults; both measurements were available on 1549 adults. We observed differences between farm and non-farm rural residents with respect to individual, contextual factors and covariates.DiscussionThere are differences between farm and non-farm rural residents with respect to individual and contextual factors and other variables of importance. The findings of the SRHS will improve knowledge of respiratory disease etiology, assist in the development and targeting of prevention programs, and in planning health services with farm and small town populations.