Oncology

Question 1

Melanoma long term surveillance for those with CR (Stage IV) on checkpoint inhibitors?

Answer 1

1. Monitor for disease recurrence: 3-6 monthly CTCAP and brain CT/MRI
2. Monitor for the complication of treatment (checkpoint inhibitors)

Regular Hx and exam for: skin exam (rash/pruritis), diarrhea/colitis, SOB (pneumonitis)

Regular blood - TFT, ACTH, FSH, LH and prolactin (hypophysitis), TFT (thyroiditis), LFTs (hepatitis), fasting glucose (0.5% chance of TIDM), EUC (rare AKI)

Question 2

Monitoring and follow-up for Check-point inhibitors?

Answer 2

Clinical history & exam

• SOB, chest pain, diarrhoea, rash
• Skin, eye (uveitis/optic neuritis), thyroid, core system exam for cardio, GI, resp, neurological toxicities
• Postural BP

Investigations

• Depending on clinical presentation
• FBC, EUC (renal toxicity), LFTs
• TFT, morning cortisol, HBA1C (TIDM) → if suspicious for hypophysitis (LH, FSH, ACTH, TSH, Prolactin, T3/4, SynACTHen, MRIB - swelling/enhancement of pituitary gland)
• TTE and PFT at baseline + repeat if suspected.

Question 3

Essential non-pharmacological Mx spiel in any cancer patients?

Answer 3

• Educate on prognosis, encourage Advanced Care Planning
• Counselling + involve psychologist with a view to support emotional + psychological challenges of cancer (CBT, existential therapy, acceptance and commitment therapy)
• Educate on early palliative care → improved outcome
• Education on importance of nutritious diet, HPHE. Dietician to minimise weight loss, maintain nutrition to withstand therapy and disease