1. What should the Geriatrician ask the Medical Oncologist?
Texte courant
Siri Rostoft, MD, PhD, Assistant Professor
Department of Geriatric Medicine,
Oslo University Hospital
University of Oslo, Norway

2. No conflict of interests
Disclosure
No conflict of interests

3. 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?

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

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

6. What would you ask the oncologist?

7. Setting 1: Work up reveals cancer in an older adult
Refer to medical oncologist
What is the prognosis?
Is there treatment available? What is the standard treatment?
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?

8. Can the 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?
What should be expected if the cancer is left untreated? Time frame? Control in 6 months?

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

11. Setting 2: Patient transferred from oncology to geriatrics
What is the prognosis of the cancer?
Is the treatment curative or palliative?
Palliative – symptoms, life-prolongation? Months?
May treatment or cancer have caused the stroke?
How will it affect the prognosis to put the cancer treatment on hold?
Are there treatment alternatives to consider?
Will evaluating stroke etiology make a difference?

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

14. Pre-treatment geriatric assessment
What is the prognosis?
Can the patient be cured?
What is the risk of treatment (complications, toxicity)?
Patient preferences discussed?
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)

15. During treatment GA Current state – cancer or treatment-related?
Again – prognosis? Cancer – relapse? Curative or palliative?
How has functional status and quality of life developed during treatment?
All alternative treatments considered?
Pre-treatment GA is very helpful, but often not done

16. Summary Prognosis Goal of treatment (curative, palliative)
Toxicity of treatment
Expected disease trajectory
How cancer affects general state of patient
What do you need from me specifically?