Tayside oncologists found the best balance

Sir, – I feel compelled to write in support of the breast oncology consultants in Tayside.

I have looked at much of the evidence and made inquiries of experts in other centres and am fully convinced from the available evidence that their variation in treatment regimen is completely justified.

In 2016, the Tayside breast oncology team audited their practice.

They noted an unacceptable incidence of side effects impacting on their ability to deliver optimum treatment to their patients, despite following a recommended guideline.

The group conducted a thorough literature review to examine how they could deliver a regimen effectively but safely.

It was decided to cap the dose of docetaxel, one drug of a four-drug regimen.

The dose they selected was taken from a large, multicentre, randomised controlled trial, which showed that survival outcomes with 80mg/ m2 were not inferior to 100mg/m2 (60% of patients in the trial were treated using 80mg/m2).

One paper shows increased survival rates with the lower dose, and significantly fewer side effects.

One pharmacist disagreed and invoked a whistleblowing process, which led to an internal review by NHS Tayside.

This review completely exonerated the medical oncology team.

Although an effective drug, the side effects of docetaxel can be horrendous and may prove fatal.

One paper demonstrated a 1% treatment-related mortality associated with 100mg/m2 dose.

Sepsis is not the only dose-limiting toxicity of docetaxel – it is a potent neurotoxin often causing severe neuropathy.

As many as 40% of patients receiving the 100mg/m2 dose fail to complete their scheduled treatment plan due to dose-related side effects.

Guidelines assume all patients are the same – we are all slightly different.

It is clear to me the consultant breast oncologists in Tayside have taken into consideration their individual patient characteristics, carefully audited their results, performed a full and diligent literature search and instituted the correct regimen for their patients. Unfortunately the same attention to detail has not been applied by others from outwith Tayside, with spurious claims of increased recurrence of tumour due to the new regimen being made.

It is uncertain if this is incompetence or selfpreservation.

Patients within Tayside should be grateful they have such caring doctors looking after them during a time of great stress and anxiety.

They need to be reassured that they have had optimum treatment, and that they can indeed have confidence in the Tayside team.

These are the doctors I would want to treat my family.

Crawford Reid. 5 Easthill Farm, Auchterarder.