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Acting Fast: A Case of Spontaneous Calculus Migration in a Patient with Bouveret's Syndrome [Meeting Abstract]

Schuster, Isaiah P.; Shklar, Victoria; Paredes, Harold; D\Souza, Lionel
ISI:000464611003130
ISSN: 0002-9270
CID: 5532082

A new care paradigm in geriatric head and neck surgical oncology

Shuman, Andrew G; Korc-Grodzicki, Beatriz; Shklar, Victoria; Palmer, Frank; Shah, Jatin P; Patel, Snehal G
BACKGROUND AND OBJECTIVES/OBJECTIVE:Perioperative management of elderly patients with head and neck cancer poses unique challenges. Our objective is to describe the implementation and feasibility of a novel intervention designed to improve perioperative care in geriatric head and neck surgery. METHODS:This pilot study was performed in a single-institution, NCI-designated comprehensive cancer center. All surgical patients with head and neck cancer over age 75 were offered perioperative consultation with fellowship-trained geriatricians focusing in geriatric oncology. RESULTS:Between 2010 and 2011, a total of 168 patients requiring head and neck surgery were seen by the geriatric service, of which 94% subsequently underwent surgery. Apart from preoperative medical optimization, geriatricians assisted in complex decision-making regarding the indications for cancer-directed therapy. Postoperatively, they assisted in preventing and treating delirium and poly-pharmacy, facilitating discharge planning, and initiating rehabilitation. Postoperatively, 87% were discharged home, and 13% required placement in skilled nursing facilities. At 24 months, overall survival was 80%. Patients, surgeons and geriatricians alike were enthusiastic about the initiative, which is expanding within the institution. CONCLUSION/CONCLUSIONS:Geriatric perioperative support for elderly head and neck cancer patients is well-received with promising potential. The tangible impact and direct benefits of this pilot initiative require additional study.
PMID: 23813637
ISSN: 1096-9098
CID: 5532072