Reference no: EM134030729
Case Study-Breast Cancer and Older Adult Ms
A a 80-year-old African-American woman has recently been diagnosed with ER-/PR-positive HER2-negative metastatic breast cancer (CA) with bone-only metastasis stage (T2N0M1). Medical history includes hypertension and diabetes with mild neuropathy. Current medications are metformin, lisinopril, gabapentin, calcium with vitamin D, multivitamin and acetaminophen as needed. She lives alone in a ground floor apartment and has no living relatives. She does not drive and relies on public transportation.
1. Which population is at high risk for breast CA? Outcome?
2. Define ER-/PR-positive HER2-negative metastatic breast CA.
3. Explain bone only metastasis T2N0M1.
4. Based on comprehensive geriatric assessment, what are several potential problems? During a consultation, the oncology team reviews the pathology; computed tomography (CT) scan of her chest, abdomen, and pelvis; and bone scan. The CT reveals no visceral metastases. The bone scan reveals one small lesion in the left middle portion of the humerus but no fracture.
5. Explain term no visceral metastases.
6. Explain small lesion of humerus, but no fracture. The oncology team agree to initiate treatment with hormonal therapy alone.
7. Why is hormonal therapy chosen?
8. Explain a social aspect which contributed to choosing an oral medication. Several agents in the aromatase inhibitor (AI) class have different side effect profiles that can be adjusted as needed for tolerability. AIs offer daily dosing without known drug-drug interactions.
9. What is a key concern in the geriatric population and medications?
10. Why is it important for Ms A to continue her usual daily medications?
11. After six months, Ms A reports to her oncologist and oncology nurse that she has been having difficulty carrying her laundry basket because of increased pain and some hip pain in the left hip. Based on images she has bony disease progression to the humerus and hip.
12. What medications would be added based on this result?
13. What treatment options and goals of care discussed? She does not have a POLST.
14. Why is radiation chosen?
15. What complications would the RN assess for?
16. What will the RN teach Ms A?
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