Therapeutic advances in cancer therapy have led to an increase in the number of patients undergoing surgery as part of their cancer treatment. These patients present several unique challenges, including weighing risks against adverse effects of delaying time-sensitive treatment and taking the patient’s cancer and its treatment into account when determining postoperative management. The following module discusses these topics, with an emphasis on cardiovascular and pulmonary toxicities of radiation and chemotherapeutic agents as well as common hematologic problems encountered in patients with cancer.

To provide hospitalists with a general approach to perioperative risk assessment and postoperative management of patients with cancer.

This activity is designed for hospitalists. No prerequisites required.

After completing the module, the participant should be able to:

1. Describe the cardiovascular toxicity of radiation and chemotherapeutic agents and unique cardiovascular risk considerations in the patient with cancer. [PC, MK]
2. Identify pulmonary toxicities of radiation and chemotherapy and their potential impact on perioperative management of the oncology patient. [PC, MK]
3. Describe common hematologic problems encountered in patients with cancer. [PC, MK]
4. Review other common adverse effects of chemotherapy and radiation therapy and organ-specific preoperative risk evaluation elements in patients with cancer. [PC, MK]
5. Anticipate and manage postoperative complications typical of the cancer patient population. [PC, MK, SB]

Accreditation Council for Graduate Medical Education General Competency Assignments

PC Patient Care

MK Medical Knowledge

IC Interpersonal & Communication Skills

PR Professionalism

SB Systems-Based Practice

PB Practice-Based Learning & Improvement

Source: Accreditation Council for Graduate Medical Education. Common Program Requirements: General Competencies. Available at: http://www.acgme.org/outcome/comp/GeneralCompetenciesStandards21307.pdf. Published: September 28, 1999. Accessed December 4, 2009.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)^™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: March 1, 2010. Expiration date: March 1, 2012.

Estimated time to complete activity: 2 hours

Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

^*Associate Professor of Medicine, Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, The University of Texas MD Anderson Cancer CenterDallas, Texas

Conflict of Interest: Dr Sahai reports having no relationships with commercial interests related to this activity.

Off-Label Product Discussion: The author has indicated that he has not referenced unlabeled or unapproved uses of drugs or devices.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: Sunil K. Sahai, MD, FAAP, FACP, Associate Professor of Medicine, Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1465, Houston, TX 77030. E-mail: SSahai@mdanderson.org.

Click here to download the references for this educational activity.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study activity, and a CME post-test. All 3 sections must be completed to receive CME credit.

Supported by an educational grant from Merck & Co., Inc.