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 srostoft@gmail.com

No conflict of interests Disclosure No conflict of interests

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

What would you ask the oncologist? www.menti.com

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?

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?

Setting 2: An older cancer patient suffers a stroke or delirium 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? 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?

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)? 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)

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

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?