Dr.Laskin`s 9.15 Diagnosis （page2）

Onc. Medical Treatment Clinic Note (Page@)

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MRN: 111567117

Patient OU, XIAOWEN

DOB: 10-Mar-1953

Encounter #. 2000004166069

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Problem List/past Medical History

GIST (resected 2016 ) 

Hydrocephalus (Ventrlouloperitoneal shunt Jan 2020)

Schizophrenia 

Superficial thromboses of varicose veins on right thigh and right calf veins (Nov 2020)

Historical (Resolved Problems)

   No problems documented

Medications

  Home Medication

No Best Possible Medication History obtained on this encounter.

Allergies

No Known Allergies

Assessment/Plan

Mrs Ou has an EGFR mutation positive NSCLC with known LM disease and a VP shunt. She has been deteriorating from a coordination and cognitive perspective and also has significant nausea that seems somewhat refractory to many medications. She remains on osimertinib but the presence of adneocarcinorna in her recent LP suggests that this drug is no longer controlling her cancer and although we cannot measure any change on her MRI it is common that LM disease can progress with clinical worsening that is difficult to measure on imaging.

I have told Mr Ou that I think her osimertinib is no longer effective and that it might be contributing to her nausea so I would stop taking it and see if she feels any better. If she does improve then they should stay off. If she gets worse then they could restart but I do not think the osimertinib is going to make any positive impact on her disease trajectory. At this point, given the cytology results and her clinical status I think her overall prognosis is limited and I told him that I felt her life was limited to weeks or maybe a few months and that we should really focus on her QOL.I do think she would be a hospice candidate from a prognostic perspective.

Mr Ou is concerned that this is from increased hydrocephalus and is asking about a 2nd opnion at VGH; I cannot faciliate that referral or discussion but I did mention this to the hospitalist physician who I spoke to after my conversation with Mr Ou.

I do realize that her decline and the lack of measurable disease progression on scans makes this hard for him to accept but unfortunately I don't have any other cancer treatments that will help her. she is certainly not a candidate for systemic IV cytotoxic chemotherapy and there are no other targeted agents avallable.

I have not made another appointment with them but I wili be happy to answer questions if they have some in the future. I wish her the best.

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Electronically signed on 15-Sep-2022

Laskin, Janessa Joy, MD