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name: langcare-oncology description: > Compiles oncology treatment timeline from FHIR data including cancer staging (TNM), treatment history (chemo, radiation, surgery), lab trends (tumor markers, CBC), and response assessment (RECIST criteria). Use when asked about oncology timeline, cancer treatment history, tumor staging, treatment response, or cancer care summary.

Oncology Treatment Timeline

When to Use This Skill

Use when a clinician needs a comprehensive cancer care timeline including staging, treatment history, lab trends, and response assessment.

Clinical Workflow

1. Use fhir_read to retrieve Patient demographics
2. Use fhir_search to pull cancer Condition resources with staging information (TNM, clinical stage, pathologic stage)
3. Use fhir_search to pull Procedure resources for surgical interventions (biopsy, resection, radiation)
4. Use fhir_search to pull MedicationRequest/MedicationAdministration for chemotherapy, immunotherapy, targeted therapy, hormonal therapy
5. Use fhir_search to pull Observation resources for tumor markers (PSA, CEA, CA-125, CA 19-9, AFP, HCG) and lab trends (CBC for myelosuppression, LFTs, renal function)
6. Use fhir_search to pull DiagnosticReport for pathology and imaging reports
7. Organize into chronological treatment timeline with staging at diagnosis and response assessments (see references/tnm-recist-staging.md)
8. Present: diagnosis summary, staging, treatment phases with dates, current regimen, tumor marker trends, key lab monitoring, and response status

FHIR Resources

• Condition -- Cancer diagnosis with staging: code (ICD-10/SNOMED), stage (TNM), onsetDateTime
• Procedure -- Surgeries, biopsies, radiation therapy
• MedicationRequest / MedicationAdministration -- Chemotherapy, immunotherapy, targeted therapy
• Observation -- Tumor markers, CBC, metabolic panel
• DiagnosticReport -- Pathology reports, imaging (CT, PET, MRI)

FHIR Query Examples

Pull Cancer Conditions

fhir_search(resourceType="Condition", queryParams="patient=[patient-id]&category=encounter-diagnosis&code=http://snomed.info/sct|363346000")

Pull Tumor Markers (PSA example)

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=2857-1&_sort=date&_count=20")

Pull Treatment History

fhir_search(resourceType="MedicationAdministration", queryParams="patient=[patient-id]&_sort=date&_count=200")

Clinical Guidelines

• AJCC TNM Staging System (8th Edition)
• RECIST 1.1 for solid tumor response assessment
• NCCN Clinical Practice Guidelines (disease-specific)
• ASCO Quality Oncology Practice Initiative (QOPI)

Interpretation Guide

• TNM staging: T (tumor size/extent), N (nodal involvement), M (metastasis). Map to overall stage I-IV
• RECIST 1.1 response: CR (complete response), PR (partial response >=30% decrease), SD (stable disease), PD (progressive disease >=20% increase or new lesions)
• Treatment timeline: organize by phase (neoadjuvant, surgical, adjuvant, maintenance, palliative)
• Lab monitoring during chemo: CBC nadir timing (7-14 days post-cycle), neutropenia thresholds (ANC <500 = severe), tumor lysis labs (K+, uric acid, phosphate, LDH)
• Tumor marker interpretation: trend is more important than single value; rising markers with stable imaging may indicate early progression

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges