Dermatomyositis is an inflammatory disease that affects muscle strength and causes skin manifestations.There is an increased incidence of cancer in patients with this diagnosis although the pathophysiology of this association is still not completely understood.We report a case of a 65-year-old man who presented to the emergency department with proximal muscle weakness, weight loss, dysphagia, enlarged supraclavicular lymph nodes, an erythematous rash in the malar and supraciliary regions, and papules in the extensor metacarpophalangeal and interphalangeal joints. He had elevated creatine kinase and positive anti-nuclear matrix protein-2 autoantibodies. The skin and muscle biopsies performed confirmed the diagnosis of dermatomyositis. A thorough investigation seeking an associated condition was conducted and a prostate adenocarcinoma was diagnosed. The patient was treated with glucocorticoids and intravenous immune globulin with dysphagia and muscle weakness improvement and therefore allowing hospital discharge. He is currently undergoing oncologic treatment.Myositis-specific antibodies have proved to be extremely useful in the diagnosis, prognosis, and management of patients with dermatomyositis. Various phenotypes of the disease can associate differently with a systemic condition (namely a malignant disease). This case illustrates a rare form of cancer presentation that every clinician, especially those who work in the emergency room or in primary care and therefore have immediate contact with many patients, must be able to recognize.
Purpose The management of older adults with breast cancer (BC) remains controversial. The challenging assessment of aging idiosyncrasies and the scarce evidence of therapeutic guidelines can lead to undertreatment. Our goal was to measure undertreatment and assess its impact on survival. Methods Consecutive patients with BC aged 70 years or older were prospectively enrolled in 2014. Three frailty screening tools (G8, fTRST, and GFI) and two functional status scales (Karnofsky performance score and Eastern Cooperative Oncology Group Performance Status) were applied. Disease characteristics, treatment options, and causes of mortality were recorded during a 5-year follow-up. In addition, we defined undertreatment and correlated its survival impact with frailty. Results A total of 92 patients were included in the study. The median age was 77 (range 70–94) years. The prevalence of frailty was discordant (G8, 41.9%; fTRST, 74.2%; GFI, 32.3%). Only 47.8% of the patients had a local disease, probably due to a late diagnosis (73.9% based on self-examination). Thirty-three patients (35.6%) died, of which 15 were from BC. We found a considerably high proportion (53.3%) of undertreatment, which had a frailty-independent negative impact on the 5-year survival (hazard ratio [HR], 5.1; 95% confidence interval [CI], 2.1–12.5). Additionally, omission of surgery had a frailty-independent negative impact on overall survival (HR, 3.9; 95% CI, 1.9–7.9). Conclusion BC treatment in older adults should be individualized. More importantly, assessing frailty (not to treat) is essential to be aware of the risk-benefit profile and the patient's well-informed willingness to be treated. Undertreatment in daily practice is frequent and might have a negative impact on survival, as we report.
Introduction: The management of older patients with breast cancer remains controversial. The difficult assessment of ageing idiosyncrasies and the insufficient evidence of therapeutic guidelines can lead to undertreatment. Our goal was to measure undertreatment and assess its impact on survival.Materials and methods: Consecutive patients with breast cancer aged 70 years or older were prospectively enrolled in 2014. Three frailty screening tools (G8, fTRST, GFI) and two functional status scales (KPS, ECOG-PS) were applied. Disease characteristics, treatment options and causes of mortality were recorded in a 5-year follow-up. We defined undertreatment and correlated its survival impact with frailty. Results: A total of 92 patients were included. Median age was 77 (range 70-94) years. The prevalence of frailty was discordant (G8: 41,9%, fTRST: 74.2%, GFI: 32.3%). A low-risk disease was not found (51.2% were N+) probably due to a late diagnosis (76.1% based on self-examination). Thirty-three patients (35.6%) died 15 of them from breast cancer. We found a considerable high proportion (53.3%) of undertreatment, which had a frailty-independent negative impact on 5-year survival (HR=5.1 [95% CI: 2.1-12.5]). Additionally, omission of surgery had a frailty-independent negative impact on overall survival (HR=3.9 [95% CI: 1.9-7.9]). Conclusion: Breast cancer treatment in older adults ought to be individualized. More important than assessing frailty (not to treat) is essential to be aware of the risk-benefit profile and the patient's well-informed willingness to be treated. The undertreatment in daily practice is frequent and might have, as we report, a negative impact on survival.
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