Deconditioned patient with metastatic lung cancer for parotidectomy

TOPIC 3:               Consult for Parotidectomy

69-year-old lady for potential resection of deep lobe of parotid – Likely carcinoma


  • New Right parapharyngeal mass on surveillance PET
  • Asymptomatic
  • Non-small cell lung cancer – Stage IV with Brain metastases
  • Complete response to palliative radiotherapy


  • COPD, moderate disease FEV1/FVC = 0.6 (79%)
  •  50 pack year smoking history
  • Deconditioned +++
  • 3.9 METS on DASI. Walks 20-30m with stick or 4WW
  • Significant clinical depression with suicidal ideation
  • Rarely leaves home


Should surgery proceed?

  • No Formal diagnosis of mass
  • Discussion with surgeon at clinic – FNA arranged. If benign then for surveillance but if malignant will require resection which is a high-risk procedure due to proximity of vascular structures

Optimisation options

  • No clinical issues identified to optimise
  • Depression and deconditioning severely impacting functional capacity
  • Prehabilitation – sometimes the social aspect can be beneficial in isolated people
  • Distance patient – need to explore options
  • GP manages significant depressive symptoms – is there any possibility of specialist input?
  • Psychiatry and psychology services currently difficult to obtain


  • Await results of FNA
  • Discuss with CPET team regarding referral to prehabilitation and role of CPET if surgery is to proceed
  • GP letter to attempt to refer to psychiatrist and/or psychologist for review of mental health symptoms