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Review reveals young cancer patients are put at risk

Systemic anti-cancer therapy — safeguards needed

Jo Carlowe

Friday, 14 December 2018

A new report into the use of systemic anti-cancer therapy in children and young adults, reveals some patients are put at risk.

The report Cancer in Children, Teens and Young Adults: On the Right Course?, published this week by the National Confidence Enquiry into Patient Outcome and Death (NCEPOD), analysed the care delivered to patients aged 24 and under who either died or had an unexpected admission to critical care within 60 days of receiving systemic anti-cancer therapy (SACT).

Overall 58% of patients were thought to have good care and there were many areas of excellent practice. However, in 22% of this high-risk group the SACT was directly responsible for death or admission to critical care or had a major role in the outcome. In a further 25% substantial toxicity was observed.

The report found that for a third of patients there was no discussion in a ‘properly constituted’ multidisciplinary team meeting, and a fifth of consent forms did not mention that SACT could be life threatening.

There was evidence that doctors felt under pressure from families to prescribe SACT, yet holistically assessing patients for their fitness to receive SACT was only performed in half (51.4%) of patients.

The report also noted that routine auditing of toxicity of SACT happened in less than half of cases, and of deaths within 60 days of treatment, in only two-thirds (43.4%).

The NCEPOD report includes a number of recommendations which it states are “largely based on factors that can be improved quickly and without large financial implications in terms of structure or equipment.”

The NCEPOD adds: “Adequately trained staff, good team working and clear local leadership are key to improving care for this vulnerable population.”

Key recommendations in the report include the following:

  • Ensure any new protocol of SACT, to a given patient, is discussed at a multidisciplinary team meeting, in advance of commencing treatment.
  • Ensure that discussions about SACT with patients and/or their parents are documented.
  • A nationally agreed consent form specific for SACT should be developed and implemented. 
  • Ensure consultant review within 14 hours of an acute admission in line with the Royal College of Paediatrics and Child Health in ‘Facing the Future’ and the Royal College of Physicians of London in the ‘Acute Care Toolkit 4’.

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