QuestionSBA
QuestionChoice
This would be inappropriate as extensive investigation are unlikely to ultimately affect treatment decisions. NICE guidelines CG104 recommend not routinely investigating to find the primary cancer, which a PET scan may be used to do. The man's age and comorbidities mean he will likely not be a candidate for active treatment.
10017273
c
Whole body FDG PET scan
QuestionChoice
This would be inappropriate as extensive investigation are unlikely to ultimately affect treatment decisions. The man's age and comorbidities mean he will likely not be a candidate for active treatment.
10017272
b
Staging CT CAP
QuestionChoice
In patients with a likely malignancy of unknown primary, in whom extensive investigation is unlikely to ultimately affect treatment decisions, NICE guidelines CG104 recommend not routinely investigating to find the primary. The man's age and comorbidities mean he will likely not be a candidate for active treatment.
10017271
a
No further investigations
QuestionChoice
While prostate cancer is a likely diagnosis, Ffurther investigations to identify the primary cancer are unlikely to be helpful in this case. In patients with a likely malignancy of unknown primary, in whom extensive investigation is unlikely to ultimately affect treatment decisions, NICE guidelines CG104 recommend not routinely investigating to find the primary. The man's age and comorbidities mean he will likely not be a candidate for active treatment.
10017275
e
Multiparametric MRI of the prostate
QuestionChoice
Bone scans are used to assess the spread of cancer to bones. In this case, the presence of a lytic lesion demonstrates that bony metastases are already present. Further scanning to locate other lesions is unlikely to be helpful, as this patient is unlikely to be a candidate for active treatment.
10017274
d
Technetium bone scan
QuestionComment
bro what
42098
QuestionComment
bro even if u do ct and find cancer somwhere what u gonna do with a guy with CKD stage 4, pulmonary fibrosis, Alzheimer’s disease, heart failure, macular degeneration and osteoporosis 
43515
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Ale
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Conor  mcgregor
QuestionComment
personally, id talk to the MDT
45000
User
subscriber
Serpiginous Defibrillator
QuestionComment
does the patient get no choice in this decision? would you not offer to find out how far along his cancer is?
50962
QuestionComment
Not sure abt the pt.'s choice in this, but in regards to how far along his cancer is, it really wouldn't matter with the results you get; you're not gonna do anything regardless of the results. Low grade cancer? -> He's unfit for surgery (this guy's probably an ASA 3 or 4). High grade cancer? -> Probably inoperable anyway.

Hope this helps :)
53511
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Retrograde Contusion
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Hypertension Power
Concept
Chapter
# Summary


WHO Performance status classification categorises patients into different groups dependent on their physical fitness, measured by their ability to perform activities of daily living. It is used to assess their suitability for chemotherapy, and has some prognostic significance. 


Chemotherapy as a treatment is not without its side effects, which can limit quality of life and have negative impacts on other comorbidities. Treatment decisions involve a risk-benefit analysis, and as such a patients' performance status has a significant bearing on what treatment options are most appropriate.


# Classification


The WHO performance status classification categorises patients as:


- 0: able to carry out all normal activity without restriction
- 1: restricted in strenuous activity but ambulatory and able to carry out light work
- 2: ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours
- 3: symptomatic and in a chair or in bed for greater than 50% of the day but not bedridden
- 4: completely disabled; cannot carry out any self-care; totally confined to bed or chair.


# References

[NICE Appendix C: WHO performance status classification](https://www.nice.org.uk/guidance/ta121/chapter/appendix-c-who-performance-status-classification#:~:text=The%20WHO%20performance%20status%20classification,to%20carry%20out%20light%20work)

[JAMA Oncology: Performance status in patients with cancer](https://jamanetwork.com/journals/jamaoncology/fullarticle/2432463)
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WHO Performance Status
Topic
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Oncology and Palliative Care
15998
In elderly patients with significant comorbidities and suspected malignancy, extensive investigations may be inappropriate if they won't alter management.
An 86-year-old man is referred for a spinal MRI due to persistent back pain. The scan shows a lytic bone lesion at the T5 vertebrae. His past medical history includes CKD stage 4, pulmonary fibrosis, Alzheimer’s disease, heart failure, macular degeneration and osteoporosis. His WHO performance status is 3.

What is the most appropriate management?
a