Objectives
  • To be able to perform specialist assessment, treatment and counselling of patients with cancer and comorbidities

Awareness
  • Recognition of the importance of interdisciplinary management of patients with cancer with comorbidities

  • Appreciation of the principles of integrating comorbidities into diagnostic and treatment decisions for patients with cancer

  • Awareness of the importance of comorbidity assessment in determining clinical trial eligibility

  • Awareness of the existence of prognostic comorbidity indices

  • Recognition of the psychosocial impact of cancer treatment in patients with comorbidities

Knowledge
  • Understanding of how comorbid medical conditions can affect the efficacy and toxicity of cancer treatment

  • Understanding that comorbidities may influence but are not equivalent to functional status

  • Understanding of how to individualise the management of different cancers in patients with comorbidities

  • Understanding of how cancer-directed treatment can lead to the exacerbation of comorbidities during or after the completion of therapy

  • Understanding of the distinction between disease progression, treatment-related toxicities and complications related to comorbidities

  • Familiarity with specific comorbidities which may be contraindications to surgery, radiation therapy, chemotherapeutics, immunotherapy or targeted therapy in different cancers

  • Familiarity with the utility and limitations of tools such as the Charlson Index in assessing the impact of comorbid medical conditions on outcomes in patients with cancer

Skills
  • Ability to perform a through and accurate assessment of a cancer patient's comorbid medical conditions

  • Ability to consider how cardiovascular, pulmonary, haematological, gastrointestinal, autoimmune, rheumatological, neurological, infectious, endocrine, dermatological and psychiatric comorbid conditions and their treatment affect a patient's ability to receive a particular cancer-directed therapy

  • Ability to discuss critically and coordinate the management of comorbidities of patients with cancer with other specialists

  • Ability to include understanding of comorbidities in referrals for radiological and interventional diagnostic and therapeutic procedures in patients with cancer

  • Ability to apply understanding of drug pharmacology to adapt and modify therapeutic plans in patients with cancer with comorbidities, including varying degrees of hepatic and renal dysfunction

  • Ability to consider comorbidities to identify frail/unfit patients with cancer and to determine clinical trial eligibility

  • Ability to incorporate comorbidities in determining the risk/benefit ratio for pursuing cancer-directed therapy and for specific anticancer agents

  • Ability to anticipate potential acute and chronic treatment-related complications (eg, neuropathy) in patients with cancer with comorbidities

  • Ability to contribute actively in the management of patients with cancer with comorbidities at the time of diagnosis, and during the initiation, transition and cessation of treatment

  • Ability to integrate the presence of comorbidities, along with age, cognitive and performance status into developing multidisciplinary treatment plans for patients with cancer

  • Ability to manage toxicities of chemotherapeutic, targeted and immunotherapeutic agents in the setting of comorbidities, including drug-dosing adjustments and administering supportive measures

  • Ability to consider drug–drug interactions when prescribing different therapeutic agents in patients with cancer with comorbidities

  • Ability to determine alternate drug regimens and schedules for patients with cancer with different comorbidities

  • Ability to discuss the role of comorbidities in treatment decision-making with patients with cancer