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Be alert to ovarian cancer, MDU warns GPs

Large rise in complaints over missed diagnosis and delayed treatment

Louise Prime

Tuesday, 18 March 2014

The Medical Defence Union has seen a large rise in the number of cases it has opened involving ovarian cancer, it reported this morning. It warned GPs that although missing such a notoriously difficult to diagnose cancer “is not necessarily negligent”, they should ensure that they are following guidance on diagnosis and referral.

Only about two in five women in England survive for at least five years after being diagnosed with ovarian cancer, according to Cancer Research UK, and 4,272 died from the disease in the UK in 2011; the high mortality, according to the National Institute of Health and Care Excellence, is because most women already have advanced disease by the time they present.

The Medical Defence Union said there has been an increase in the number of cases and complaints involving diagnosis and treatment of ovarian cancer. Between 2009 and 2013 it opened 133 claims and assistance files involving ovarian cancer, reported by GPs and hospital doctors, a 45% increase on the 92 cases in the preceding five-year period.

Of all 225 cases over the decade, more than 80% related to alleged failure to carry out an appropriate examination, diagnose the disease, or to make an urgent referral for treatment; other allegations related to doctors’ treatment of the patient, including pain management and failure to make home visits. The MDU has issued advice to help reduce the risk of delayed treatment, and thus significantly improve a patient’s prognosis. This includes:

  • Consider relevant clinical guidelines such as NICE’s Ovarian cancer: The recognition and initial management of ovarian cancer (issued April 2011), which covers detecting the disease in primary care, referral and confirming the diagnosis in secondary care.
  • Ensure a thorough history and details of the examination are documented in the records, along with the differential diagnosis and management plan. Record negative as well as positive findings.
  • If a potential diagnosis of ovarian cancer is being considered, appropriate steps should be taken to exclude this.
  • If an examination or test identifies signs suggestive of ovarian cancer, make an urgent referral in line with the NICE guidance.
  • Ensure that patients, who you do not think are suffering from ovarian cancer, are aware of likely response times for symptoms to resolve or treatment to take effect – and the need to return if symptoms continue.

MDU medicolegal adviser Dr Richenda Tisdale said: “Failure to diagnose ovarian cancer is not necessarily negligent as the symptoms are non-specific and can be similar to those of more common conditions, such as irritable bowel syndrome. In some cases patients with a sizeable ovarian tumour may have only mild symptoms or none at all. However, for patients and their families ovarian cancer can be a devastating disease and many are understandably angry if an opportunity to make a correct diagnosis was apparently missed.”

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