What should the Geriatrician ask the Medical Oncologist

What should the Geriatrician ask the Medical Oncologist? Siri Rostoft, MD, Ph. D, Assistant Professor Department of Geriatric Medicine, Oslo University Hospital University of Oslo, Norway srostoft@gmail. com

Conflicts of Interest None to Declare

Mr A - man with rectal cancer 69 years old, home dwelling Locally advanced rectal cancer Admitted for preoperative chemoradiotherapy according to guidelines (MDT decision) After a week non-cooperative, pulled out i. v. lines, completely bed-ridden, aggressive What do we call this? Any risk factors?

What does the geriatrician ask? How was the patient´s preoperative functional status?

Setting 1: Your discover a diagnosis of cancer in your older patient

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Setting 1: Work up reveals a malignant tumor in an older adult • Refer to medical oncologist What is the prognosis? Is there treatment available? How toxic is the treatment? Do we need to rush to start treatment (room for prehabilitation/optimization)? • What complications can we expect from the cancer? • •

• Can the finding of cancer explain my patient´s current state? • Will the treatment affect any organ system in a specific way (ex kidneys, heart optimization)? • What tests should I order before the patient sees you?

Setting 2: An older cancer patient suffers a stroke and is transferred to your ward

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Setting 2: Patient transferred from oncology to geriatrics • What is the prognosis of the cancer disease? • Is the treatment curative or palliative? • How will it affect the prognosis to put the cancer treatment on hold? • Are there treatment alternatives to consider?

Setting 3: The oncologist calls you and asks for a frailty assessment in an older cancer patient

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Pre-treatment geriatric assessment • What is the prognosis? • Can the patient be cured? • What is the risk of treatment (complications, toxicity)? • Does cancer explain my patient´s current state (i. e. lymphoma)? • Are there alternative treatment strategies? • Will the treatment affect any organ system in a specific way (ex kidneys, heart - optimization)

Summary • • • Prognosis Goal of treatment Toxicity of treatment Expected disease trajectory How cancer affects general state of patient • What do you need from me specifically?