Cancer drug deaths spark concerns about quality of care
More caution is needed when prescribing chemotherapy, concludes national audit
Wednesday, 12 November 2008
Questions have been raised about the quality of cancer care, following the publication today of a national report into deaths of patients given cancer drugs.
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reviewed clinical practice and hospital facilities for 600 cancer patients, all of whom died within 30 days of receiving chemotherapy.
It found that chemotherapy probably caused or hastened death in more than one in four (27%) of these cases.
More than four out of 10 patients (43%) experienced significant toxicity related to treatment, and one in five (21%) were already severely debilitated at the time the decision to treat with chemotherapy was taken.
The report says that consultants should consider reducing the chemotherapy dose for severely debilitated patients, those who have other serious illnesses, and those who have already had several previous courses of treatment.
Only just over one in three of the patients (35%) received good quality care, and more than four out of 10 (42%) were admitted to general medical wards rather than a specialist oncology unit.
The report recommends that hospitals treating patients with chemotherapy, which do not have facilities to manage people who are acutely unwell, should have a formal transfer agreement with another hospital with the appropriate provision, it says.
Surgical oncologist Mr Mark Lansdown, who co-wrote the report, says that while side effects are common, very few people die after being given chemotherapy.
But he cautioned that most patients in this study “were receiving palliative treatment where the aim is to alleviate symptoms with the minimum of side effects.”
He added that NCEPOD advisors believed that more than one in four of the patients had died as a result of contributory factors from the treatment:
“This is of particular concern for the 14% of patients in this study for whom the treatment was intended to cure them of their cancer,” he said.
Clinical oncologist and co-author, Dr Diana Mort called for more oncologists to become involved in clinical audit, adding: “Cancer networks and cancer service managers should ensure there are systems in place to review the management of all cases of life threatening infections– one of the most serious complications following chemotherapy.”
The report says that all deaths within 30 days of chemotherapy treatment should be considered at a “morbidity and mortality” or clinical governance meeting.
NCEPOD advisors also raised concerns about whether cancer patients are given enough information about chemotherapy to allow them to give informed consent to treatment.
The advisors found that the decision to treat was inappropriate for almost one in five (19%) of patients in the study.
Dr Mort said: “The process of consent may require more than one discussion. Patients must be made aware of the risks and side effects of chemotherapy as well as the potential benefits. They should be given time to reflect on their decision and must always be free to change their minds.”
NCEPOD Chairman Professor Tom Treasure said: “Chemotherapy has transformed the outlook for many cancer patients. However, our study asked difficult questions and found some unpalatable answers about decisions made in the weeks before they died”
For better, for worse?: www.ncepod.org.uk