TOPIC 3:               Consult for Parotidectomy

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

Background:

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

Issues

• 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

Discussion

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

Plan:

• 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