Session Title: AA 2021 Virtual Posters - General Rehabilitation
Session Time: None. Available on demand.
Disclosures: Sean M. Silverman: No financial relationships or conflicts of interest
Case Diagnosis: Determining oncologic treatment plans based on fitness
Case Description: 84-year-old male with multiple comorbidities and T2N0M0 invasive urothelial carcinoma. He underwent TURBT and was referred to oncology for treatment options. Oncology considered low dose chemotherapy with radiation. Radiation oncology determined the area of involvement in the bladder was too large, which would make radiation therapy sub optimal. Patient referred for geriatric assessment consultation to determine fitness for standard of care treatment; preoperative chemotherapy followed by cystectomy
Setting: Outpatient geri-oncology clinic, tertiary care academic centerAssessment/
Results: Determining fitness for cancer patient’s treatment plans is made through a combination of history taking along with physical exam findings and risk assessment calculators. A Short Physical Performance Battery (SPPB) and Blessed Orientation/Memory/Concentration (BOMC) test did not reveal impairments with physical or cognitive reserve. The Cancer and Aging Research Group (CARG) score determined the patient was at high risk of chemotherapy toxicity. Lee/Schonberg Index showed the patient had a reasonable 5 year survival at 75% (excluding his cancer diagnosis). Thus, undergoing the cystectomy would provide a mortality benefit. The ACS NSQIP surgical risk calculator determined this patient to be at lower risk of serious complications from cystectomy than the average person his age (18%).
Discussion: On initial glance it would appear that an 84 y/o with invasive bladder cancer would not be deemed a surgical candidate. Fortunately for this gentleman, there are risk stratifying tools and objective physical exam findings that allow for an objective assessment of surgical fitness that focuses on more than chronologic age.
Conclusion: As the world of cancer rehabilitation evolves, it is important for physiatrists to be aware of risk assessment calculators and objective tools that can be used to help determine appropriate oncological and surgical treatments. It is also possible these resources can help determine candidacy for acute inpatient rehab in cancer patients moving forward.
Level of Evidence: Level V
To cite this abstract in AMA style:Silverman SM. Age Is Just a Number: A Multifactorial Approach to Assess Tolerance to an Oncologic Treatment Plan. A Case Report [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/age-is-just-a-number-a-multifactorial-approach-to-assess-tolerance-to-an-oncologic-treatment-plan-a-case-report/. Accessed September 28, 2023.
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