ABSTRACT
The use of statins for primary prevention in older adults remains controversial. In this manuscript, we present a case of an 81-year-old woman with a history of HTN, HLD, Alzheimer's dementia and osteoporosis, who presented to a geriatrics clinic with profound muscle weakness accompanied by new functional deficits in the setting of taking double her prescribed dose of atorvastatin. She was admitted to the hospital where she was found to have rhabdomyolysis. Muscle biopsy and serologic work up revealed anti-HMG statin co-reductase myopathy as the cause of her symptoms. The patient was treated with steroids IVIG and immunomodulators with marked improvement in her weakness; however, her course was complicated by delirium and multiple falls, resulting in several fragility fractures. This case highlights the need to conduct a risk-benefit analysis prior to initiating new therapies in patients with limited life expectancy, including the consideration of the potential for medication errors.
ABSTRACT
PURPOSE: Childhood cancer survivors are at risk for deficits in health-related quality of life (HRQL) as they age. Youth (8-12 years) and adolescent (13-20 years) versions of the Minneapolis-Manchester Quality of Life Instrument (MMQL) have been developed to address survivor-specific issues and are currently in use; the MMQL-Adult Form has now been developed to assess HRQL in childhood cancer survivors aged 21-55 years. METHODS: The MMQL-Adult Form was administered to 499 adults: 65 cancer patients on-therapy, 107 off-therapy, and 327 healthy controls. Forty-four percent of patients were under 30 years old at cancer diagnosis. Principal components analysis was performed. We evaluated internal consistency reliability, stability (re-administration of the MMQL-Adult Form 2 weeks later), construct validity (concurrent administration of the SF-36), and known-groups validity (score comparisons across the three groups). RESULTS: Principal components analysis resulted in retention of 44 items across six scales: social functioning, physical functioning, cognitive functioning, outlook on life, body image, and psychological functioning. Internal consistency (Cronbach's α) was 0.80-0.90 for individual scales and 0.95 overall. Strong intraclass correlations (0.98 overall) indicated high stability. The MMQL-Adult Form distinguished between known groups; healthy controls scored better than patients on four of six scales. The MMQL-Adult Form scales correlated highly with similar SF-36 scales, demonstrating construct validity. CONCLUSIONS: The MMQL-Adult Form is a reliable and valid self-report instrument for measuring multidimensional HRQL in cancer survivors. Development of this instrument ensures availability of a tool enabling cross-sectional and longitudinal assessment of HRQL in childhood cancer survivors as they age.
