The Courier & Advertiser (Perth and Perthshire Edition)
Breast cancer review finds lower doses of chemotherapy ‘unlikely’ to have caused deaths.
Courier obtains ‘formal report’ of health chief’s review findings
A review into the deaths of 14 patients who were offered lower than standard chemotherapy doses by NHS Tayside has found it is “unlikely” the treatment had an effect on their prognosis.
Dr David Dunlop, the Scottish Government’s senior medical officer for oncology, was asked to review case notes to establish whether “appropriate standards of care and consent were applied, and also whether general professional standards were followed”.
While his findings have never been released publicly, The Courier has obtained the “formal report in the form of a letter” sent by Dr Dunlop to NHS Tayside chief executive Grant Archibald and medical director professor Peter Stonebridge.
Dr Dunlop said it was “highly unlikely that such a variation in doses of chemotherapy would have an impact on outcome (effectively recurrent disease), within one to three years of treatment for resected breast cancer”.
His review found of the 14 patients identified by NHS Tayside as being diagnosed and treated within the relevant time period who were now deceased, two records “were not in fact relevant”.
One patient died of a separate condition, while another died after long term care.
A third individual declined adjuvant chemotherapy and also died.
Dr Dunlop noted the remaining patients had an average age of 48.
He said this was an “exceptionally low average age for a cohort of patients and would imply that they had aggressive breast cancer at an early age”.
Several “either had metastatic breast cancer at presentation” or developed it on treatment.
Dr Dunlop found all these individuals had “very poor prognosis breast cancer at presentation”.
He said: “Treatment given with a reduction in chemotherapy doses of the magnitude in question would have unaffected the outcome in my opinion.”
The case notes showed a patient was treated with a higher dose but died after developing metastatic disease.
Several of the group died from treatment toxicity or rapidly progressive disease.
Dr Dunlop said: “This cohort of patients were a young group of patients with aggressive breast cancer who would have been likely to develop metastatic disease early.
“In my view, that prognosis would have been unlikely to have been affected by a variation in administered chemotherapy.
“I would also report that I found no evidence of anything other than exemplary practice around consent and communication in the records reviewed.
“Documentation, communication and clinical decision making were evident and robust.
“I found no evidence of poor practice or poor decision making in any record reviewed.”
I found no evidence of poor practice or poor decision making. DR DAVID DUNLOP