Oncology

Question 1

What is a recommendation for assessment regarding OA receiving chemo from the new ASCO guidelines?

Answer 1

65+ yo receiving chemo
Geriatric assessment should be used to identifying vulnerabilities or other geriatric impairments
Used to guide management/tx interventions

Question 2

What outcomes in chemotherapy can geriatric assessment help predict?

Answer 2

Toxicity of treatment
Functional decline
Cognitive decline
Post op complications

Question 3

What factors predict overall survival in OA being treated for cancer?

Answer 3

Functional status
Nutritional status
Overall fitness
Mental health

Question 4

What are the components of the ASCO Practical Geriatric Assessment?

Answer 4

Comorbidity (OARS, hearing vision)
Physical performance (falls, 4 m walk)
Functional status
Nutrition/weight loss (MNA)
Social support
Psychological (GDS)
Cognitive function (Mini Cog)
Geriatric Assessment screening tool
Chemo toxicity (CARG)

Other
Fatigue (Mobility Tiredness Test)
Geriatric Syndromes
Polypharmacy (Beer’s, stopp/start)

Question 5

What tools can be used for geriatric oncology assessment?

Answer 5

Practical Geriatric Assessment - looks at physical function, functional status, nutrition, social support, psychological comorbidity, cognitive function, risk of chemo toxicity

Question 6

What tools can be used to estimate life expectancy in oncology?

Answer 6

Schonberg Index
Lee Index

Question 7

What tool is used to assess risk of chemo toxicity?

Answer 7

CARG toxicity tool

Question 8

What did the GAP70+ trial find for outcomes?

Answer 8

Patients who had a GA identified vulnerability
Planned to receive new tx regimen
Had less severe chemo toxic effects, fewer falls, more meds discontinued

Question 9

What are breast cancer screening recommendations?

Answer 9

F
50-60, mammo q2-3 yrs
70-74, mammo q2-3 yrs

Question 10

What are cervical cancer screening guidelines?

Answer 10

30-69 pap q3 yr
70+ if adequate screen (3 negs in last 10 years) stop routine screening

Question 11

What are colorectal cancer screening guidelines?

Answer 11

60-74 yo = FOBT q2 yr, flex sig q10
75+ = don’t screen

Question 12

What are screening guidelines for esophageal cancer?

Answer 12

Do not screen adults with chronic GERD for esophageal cancer unless alarm symptoms

Question 13

What are screening guidelines for lung cancer?

Answer 13

55-74 yo
Min 30 pyh
Currently smoking OR quit <15 yrs ago
Annual low dose CT up to 3 times

Question 14

What are the prostate screening guidelines?

Answer 14

No screening recommended with PSA regardless of age

Question 15

What general reasons should cancer screening be stopped for?

Answer 15

Life limiting diagnosis
Not willing to accept risks
Wouldn’t receive tx if cancer detected

Question 16

What are potential harms of cancer screening?

Answer 16

Mammo - false positive rate
Colonoscopy - perforation, bleed, stroke

Question 17

What are challenges of a non-geriatrician performing CGA in oncology setting?

Answer 17

1. Time constraints
2. Lack of resources
3. Knowing which tools to use
4. Lack of expertise

Question 18

What are top 3 cancers that metastasize to the brain?

Answer 18

Lung
Breast
Skin
Colon
Kidney

Question 19

At what age is it recommended to stop PSA screening if elected to do so? If life expectancy is less than how many years should you stop screening?

Answer 19

70 yrs old stop elective
10 yrs life expectancy stop

Question 20

What are common objections of patients to stopping screening?

Answer 20

Want to live longer
Want to have information
What to get treatment
Fear of cancer
Peace of mind