Generic Template

Oncology History Template

Diagnosis:

Initial diagnosis - Date ( typically date of first biopsy)

• Presentation: self palpated lump, screening mammogram, iron def anemia, bowel obstruction, abnormal weight loss, abnormal bleeding, incidentally detected elevated PSA, obstructive uropathy symptoms, dyspnea, weakness, falls
• Description of presentation:
• Imaging at presentation
• Initial diagnosis pathology and tumor markers

Treatment history:

First Progression: ( date)

• Imaging at progression ( date)
• Tumor markers at progression
• Pathology/NGS if repeated
• Treatment at progression

Second Progression: ( date)

• Imaging at progression ( date)
• Tumor markers at progression
• Pathology/NGS if repeated
• Treatment at progression

 A/P 

@age yo @gender  with 

• Diagnosis: 
• Stage: TNM ( .oncstage)
• Goals of treatment: Curative or palliative
• Menopausal status: for breast cancer
• ECOG:
• Comorbid conditions: No hx of stroke, CAD, VTE. Hx of controlled hypertension and diabetes.
• Obesity .bmi ( Specify)-NCCN recommends chemo dose for actual BMI if curative intent

Assessment:

1. Functional status/ Geriatric assessment/ 

2. Social support and additional concerns

3.  Family history and need for germline testing

4. Availability of clinical trials and patient's interest in trial participation

5. Prior organ transplant/ autoimmune conditions/ long term steroid use

6. Fertility issues if applicable: Need for Lupron

Discussion:

We discussed NCCN guidelines. Based on these, current standard of care treatment involves (neoadjuvant/ adjuvant) chemo or chemo immunotherapy.

Decision regarding treatment was made after taking into consideration disease factors such as stage, current guidelines, patient factors including comorbid conditions, patient preferences and prior treatment.

The role of chemotherapy is to eliminate micrometastases and improve survival. When chemotherapy is administered before surgery, it  often shrinks the tumor and improves the chances of negative surgical margins. Based on the final pathology report at surgery, additional treatment in the form of the same or different chemotherapy or PARP inhibitor may be indicated.

OR Discussion regarding utility of Oncotype to determine chemo

Prognosis: ( if patient requests). If stage 4, emphasize disease is not curable ( except in rare situations)

Recommendations:

1. Completion of staging work up with ( CT, PET, MRI brain, bone scan, PSMA PET). Echocardiogram, baseline EKG, baseline labs CBC, CMP, phosphorus and magnesium if indicated. NGS panel testing or PDL1if indicated.

2. Port placement

3.   Sequence of treatment reviewed: chemotherapy followed by surgery. Depending on the pathology report, if no path CR, plan for additional treatment may include more chemotherapy or PARP inhibitor. Adjuvant endocrine therapy with aromatase inhibitor, need for bone density monitoring briefly discussed.

4.Neoadjuvant/ Adjuvant /Palliative chemotherapy: 

Chemotherapy regimen  recommended: TCHP/ weekly carboplatin with taxol with pembrolizumab q 6 weeks for 12 weeks followed by DDAC.

5. We discussed side effects of the treatment.  The common side effects include fatigue, neutropenia, neutropenic fever, elevation in liver enzymes, neuropathy, hearing damage ( cisplatin), skin rash. Chemotherapy is associated with a low but well known risk of death due to complications.

Immunotherapy treatment can cause severe including life limiting side effects in 10-15% patients. 

NCCN patient hand out provided.

6. Logistics of chemo including frequency/ additional chemo teaching will be provided by RN/ pharmacist.

7.  Plan for monitoring: Review of side effects, Labs during chemo visits, CT or PET image per guidelines, echo q 3 months

8. Germline testing:  Family history reviewed. Based on NCCN guidelines, this is indicated OR not indicated.

9. Referral to Social worker for counseling

10. Supportive care

- primary VTE prophylaxis: Khorana score e.g pancreatic cancer /myeloma ASA or warfarin for myeloma. 

-antimicrobial prophylaxis support

- bone support agents

- Growth factor support

-calcium and vitamin D supplementation unless contraindicated

11. Comorbid conditions were reviewed and taken into consideration in the choice of chemo treatment

-DM

-HTN

-Atrial fibrillation/CAD

-VTE/Chronic anticoagulation :Any current anticoagulants or antiplatelet and if continued use indicated? Concerns with treatment induced thrombocytopenia

-Baseline neuropathy