A new report into a NHS Tayside breast cancer scandal has urged the health board make sweeping improvements to its oncology department to ensure better care for cancer patients in the future.
Among these are instructions for the health board safety committee to investigate the cases of two patients given “inappropriate” chemotherapy treatment.
The Royal College of Physicians (RCP) published its report on the Clinical Record Review of NHS Tayside breast oncology this week.
More than 300 patients, including 14 who have since died, were given reduced amounts of the treatment by doctors at NHS Tayside between December 2016 and March 2019 in an attempt to reduce serious side effects and long-lasting secondary conditions.
RCP looked into the case notes of 24 women between September 2019 and February 2020 and noted that on 11 occasions they were given lower doses of drugs “without a clear rationale documented”.
Seven cases were considered ‘poor care’ for the phase clinical decision making.
Of these cases the review team identified that the cancer treatment was “outside of recommended guidelines”.
In five cases the dosage of FEC-T (docetaxel and epirubicin) was lower than the standard dose recommended by clinical trial data.
Further to these five cases, in one case the patient was prescribed an “inappropriate” drug regime with respect to their age and clinical presentation, and in another case the patient received an incorrect (high dose) of docetaxel, which was promptly corrected.
Seven cases were considered ‘adequate care’ where the review team identified that the patient’s treatment regimens were appropriate but “fell short of good care”.
Four cases graded as ‘good care’ for clinical decisions with the review team concluding that the treatment regime was “appropriate with standard dosing prescribed” according to recognised guidelines.
The review panel felt significant complications in her care “were potentially avoidable if the appropriate regimen was considered in the first instance”. In order to make improvements the report made numerous recommendations to NHS Tayside, from immediate changes to longer-term adjustments over 24 months.
These include the health board resetting their prescribing quotas to fall in line with national guidelines and using examples from other health boards.
Two cases with “inappropriate” chemotherapy treatment should be reviewed by the health board’s governance committee and be subject to “duty of candour if appropriate”.
If recommendations are made not to adhere to the guidelines in any case, then “specific consent” should be obtained from the patient to proceed.
It is also recommended that during the patient’s care journey there should be formal documentation of their performance status “at every stage”.
Further considerations include a review of the oncology MDT systems at other health boards to “provide guidance and learning” and the need to bring in an experienced, senior breast oncologist advisor to provide “clinical oversight”.
The findings raise further questions over investigations into the breast cancer scandal in Tayside after Dr David Dunlop’s Scottish Government-commissioned review “found no evidence of anything other than exemplary practice”.
The General Medical Council also cleared the Tayside consultants of any wrongdoing on consent, as did internal reviews by the health board.
In response to the RCP report an NHS Tayside spokesperson said: “The RCP team has also made a number of recommendations to strengthen governance, review policies and procedures and improve multi-disciplinary working.
“NHS Tayside has accepted the RCP report’s recommendations in full and clinical teams are developing an action plan in response.
“The current Tayside oncology team has delivered significant improvements since the RCP’s reporting period, which runs up to February 2020, including changes to leadership, consenting processes and clinical governance.
“The team are very keen to reassure patients that breast oncology services continue to be delivered here in Tayside, except for radiotherapy sessions for around six to seven patients per week.
“The new action plan in response to the RCP report will run alongside the current Tayside oncology team’s own improvement plans as they seek to deliver their ambition to rebuild Tayside cancer services.
“The multi-disciplinary group of staff is committed to deliver the best services they can for patients.”
