Oct 22, 2021
The ASCO Oncology Self-Assessment Series on ASCO Connection consists of free case-based multiple-choice practice questions, educational links, and answer rationales. Questions are developed by a group of oncology experts in multiple tumor topic areas. The self-assessment questions are aligned with the American Board of Internal Medicine (ABIM)’s Medical Oncology blueprints and ASCO’s Medical Oncology In-Training Exam (ITE) blueprints.
Find more self-assessment questions at ASCO Education.
Correct answers are listed at the bottom of the page.
Question 1: Supportive Care
A 70-year-old woman patient has completed concurrent chemotherapy and radiation for locally advanced non-small cell lung cancer. She has a very good response to the treatment and is now under surveillance. She comes to your office 3 months after treatment and complains of fatigue. The fatigue is significant and affects her activities of daily living. You do a complete evaluation including blood work, thyroid and adrenal function. She has no evidence of recurrent disease. The patient does have some anemia with a Hgb 10.0 g/dl.
Which of the following is the most appropriate therapy?
- Tell the patient that she should get plenty of rest and refrain from activities that promote her fatigue.
- Consider prescribing a psychostimulant such as methylphenidate.
- Consider a short course of steroid therapy.
- Suggest an exercise program appropriate for her age and typical level of activity.
Question 2: Head and Neck Cancers
A 55-year-old man with oropharyngeal cancer stage T3N2 stage IVa was treated with high dose cisplatin and radiation for 7 weeks. He completed his therapy 12 months ago. He improved initially, but now complains on severe fatigue, forgetfulness, dry skin, no sexual drive. He has dry mouth, but he can eat solid food.
Which of the following is the most appropriate next step?
- Order PET/CT scan to r/o brain metastatic disease.
- Start patient on amphetamines.
- Check TSH and free T4.
- Explain to patient that this is normal part of the process and he may never feel back to normal.
- Send patient to psychiatrist to evaluate for possible depression.
Question 1 Rationale and References
Correct Answer: D. Suggest an exercise program appropriate for her age and typical level of activity.
Rationale: Exercise is a commonly recommended therapy for cancer-related fatigue. Psychostimulants, such as methylphenidate, do not currently appear to be beneficial.
- Bower JE, Bak K, Berger A, et al. J Clin Oncol. 2014;32:1840-50.
- Puetz TW, Herring, MP. Am J Prev Med. 2012:e1-e24.
Question 2 Rationale and References
Correct Answer: C. Check TSH and free T4.
Rationale: The overall incidence of posttreatment hypothyroidism was 15% in 198 patients followed up for a mean of approximately 12 months. Hypothyroidism developed in 12% of patients treated with nonlaryngeal surgery and radiotherapy. The group undergoing total laryngectomy (with thyroid lobectomy) and radiotherapy had a 61% incidence of hypothyroidism. The average time to detection of hypothyroidism was 8.2 months.
- Sinard RJ, Tobin EJ, Mazzaferri EL, et al. Arch Otolaryngol Head Neck Surg. 2000;126:652-7.
Originally published January 2019; reviewed and updated October 2021.