64yo pancreatic ca. Diagnosed 12/12 ago. Questionable resectability due to proximity to hepatic artery, so had chemotherapy, followed by radiotherapy to improve surgical prospects. Remains uncertain.

Background:

• Quit smoking 12months ago
• Dyslipidaemia
• Pancreatic cancer
• Asthma/ COPD – nil exacerbations this year. Exacerbation last year requiring steroids.

Issues:

• Perioperative risks:
  • CPET – results in low risk stratum although some respiratory limitation
  • Frailty score 2 
  • NSQUIP suggesting low risk of death, 30% risk of serious complication

• Lack of advanced care planning

• Optimisation opportunities?
  • Prehabilitation specialist arranging local exercise program

Discussion:

• Advanced care planning discussions must always be offered but must be tailored to individual patients and their preferences around discussing these issues. 

Plan:

• patient has been referred for advanced care directive 
• proceed, nil further optimisation required