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1.
J Neurooncol ; 148(3): 545-554, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32524392

ABSTRACT

INTRODUCTION: To assess the management of immunocompetent patients with primary central nervous system lymphomas (PCNSL) in Spain. METHODS: Retrospective analysis of 327 immunocompetent patients with histologically confirmed PCNSL diagnosed between 2005 and 2014 in 27 Spanish hospitals. RESULTS: Median age was 64 years (range: 19-84; 33% ≥ 70 years), 54% were men, and 59% had a performance status (PS) ≥ 2 at diagnosis. Median delay to diagnosis was 47 days (IQR 24-81). Diagnostic delay > 47 days was associated with PS ≥ 2 (OR 1.99; 95% CI 1.13-3.50; p = 0.016) and treatment with corticosteroids (OR 2.47; 95% CI 1.14-5.40; p = 0.023), and it did not improve over the years. Patients treated with corticosteroids (62%) had a higher risk of additional biopsies (11.7% vs 4.0%, p = 0.04) but corticosteroids withdrawal before surgery did not reduce this risk and increased the diagnostic delay (64 vs 40 days, p = 0.04). Median overall survival (OS) was 8.9 months [95% CI 5.9-11.7] for the whole series, including 52 (16%) patients that were not treated, and 14.1 months (95%CI 7.7-20.5) for the 240 (73.4%) patients that received high-dose methotrexate (HD-MTX)-based chemotherapy. Median OS was shorter in patients ≥ 70 years (4.1 vs. 13.4 months; p < 0.0001). Multivariate analysis identified age ≥ 65 years, PS ≥ 2, no treatment, and cognitive/psychiatric symptoms at diagnosis as independent predictors of short survival. CONCLUSIONS: Corticosteroids withdrawal before surgery does not decrease the risk of a negative biopsy but delays diagnosis. In this community-based study, only 73.4% of patients could receive HD-MTX-based chemotherapy and OS remains poor, particularly in elderly patients ≥ 70 years.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Central Nervous System Neoplasms/mortality , Chemoradiotherapy/mortality , Cranial Irradiation/mortality , Delayed Diagnosis/statistics & numerical data , Immunocompetence , Lymphoma, Non-Hodgkin/mortality , Adult , Aged , Aged, 80 and over , Carmustine/administration & dosage , Central Nervous System Neoplasms/diagnosis , Central Nervous System Neoplasms/immunology , Central Nervous System Neoplasms/therapy , Cytarabine/administration & dosage , Female , Follow-Up Studies , Humans , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/immunology , Lymphoma, Non-Hodgkin/therapy , Male , Methotrexate/administration & dosage , Middle Aged , Prognosis , Retrospective Studies , Survival Rate , Young Adult
2.
Soc Sci Med ; 61(2): 333-41, 2005 Jul.
Article in English | MEDLINE | ID: mdl-15893050

ABSTRACT

The impaired health of a person who has committed suicide is often suggested among the proximate causes of suicidal behaviour. The introduction in 1997 of multiple-cause-of-death coding by the Australian Bureau of Statistics provided an opportunity to examine health impairments recorded on the death certificates of suicides. Data for the quinquennium 1997-2001 revealed a high prevalence of mental and behavioural disorders, in particular among women and among young and adolescent suicides. Comparison of multiple causes of death attributed to those who died in accidents with those recorded as suicides revealed that of the chronic and terminal illnesses, HIV and cancer were probably the conditions likely to trigger suicidal action.


Subject(s)
Cause of Death , Disease/psychology , Suicide , Australia/epidemiology , Death Certificates , Female , Humans , Male
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