63yo SCC ear for pinnectomy

Background

• Severe COPD
  • Frequent exacerbations
  • Still smoking
  • Regular steroids for 2yrs, unable to wean
  • Recent commencement of azithromycin, significant improvement
• Lives alone, functional

Issues:

• Multiple teams involved but lack of ownership – ENT, radonc, plastics
  • Patient receiving misinformation (or lack of information) regarding surgical plan, likely cosmetic outcome, effects on hearing.
  • Verdict reached that patient was palliative and only suitable for radiotherapy, although not clear how this decision was made.

Discussion

• Challenging when multiple teams involved but no MDT in place
• Perioperative clinicians/service often ideally placed to coordinate the patient’s perioperative journey

Plan:

• Patient requires repeat surgical consultation to fully understand the procedure and provide informed consent.
• Pt seems appropriate for both radiotherapy and surgical procedures