Doctors blast ‘inaccurate’ chemo dosage row report

Furious oncologists hit back, saying breast cancer treatment probe ‘distorts facts’

Doctors in Tayside warned a “factually inaccurate” report into breast cancer treatment had frightened patients and undermined confidence in their profession, according to a leaked document.

Members of the health board’s oncology team issued a scathing “right of reply” to a Healthcare Improvement Scotland (HIS) report commissioned after around 200 patients were given lower than standard chemotherapy doses.

In the detailed response, doctors claimed the report “distorts the facts” of the situation and had “frightened a vulnerable population and undermined their confidence in the health professionals who care for them”.

A Scottish Government spokeswoman said an action group will meet in two weeks to discuss taking forward 19 recommendations drafted following the publication of the HIS report.

She said: “We can now assure all women with breast cancer in Tayside that they will be treated in the same way as any other patient in Scotland.”

Doctors in Tayside warned a “factually inaccurate” report into breast cancer treatment in the region had frightened patients and undermined confidence in their profession, according to a leaked document.

Members of the health board’s oncology team issued a scathing “right of reply” to a Healthcare Improvement Scotland (HIS) report, commissioned after around 200 patients were given lower than standard chemotherapy doses.

The document, which has never before been made public, was written after outraged oncologists were presented with the finding of the HIS report.

In the detailed response, doctors claimed the HIS report “distorts the facts” of the situation and had “frightened a vulnerable population and undermined their confidence in the health professionals who care for them”.

The reply rails against the suggestion NHS Tayside was at “variance” with other health boards and accuses HIS of failing to prove uniformity of doses elsewhere.

It notes a recent UK study in which the majority of oncologists chose to treat patients with the same lower dose and states there is “no published data” to suggest patients in Tayside may have come to harm as a result of their treatment.

The doctors argue good practice around consent is universally accepted to relate to regimen rather than dose, and that if this was to be altered across health boards it would have “significant ramifications” for NHS Scotland.

They said HIS’s view that practice in Tayside “may not be truly informed in nature” was the “non-witnessed, non-evidenced opinion of a nonexpert panel, not one of whom have ever initiated consent of a patient for chemotherapy”.

Chief medical officer Dr Catherine Calderwood commissioned an independent risk review which stated patients in Tayside were put at a 1% to 2% increased risk of having their cancer return. The finding has been disputed by a number of experts.

The oncologists’s right of reply notes the review group, by their own admission, did not consider published literature or information submitted by the oncologists “in any depth” and instead focused on opining on the findings of the HIS panel.

It labels the risk assessment an “expert review of an inexpert report” and the doctors concluded it “does not constitute a fair assessment of a complex situation”.

A Scottish Government spokeswoman said the oncologists’ reply had not previously been shared with ministers.

“We sympathise with all the women involved and we are clear that patients deserve the best care and treatment possible,” she said.

“We can now assure all women with breast cancer in Tayside that they will be treated in the same way as any other patient in Scotland.

“Our action group will be meeting in two weeks and will take forward a range of recommendations from the independent review into this issue.”

An NHS Tayside spokeswoman said patients are treated as individuals with treatments tailored to specific needs and in line with regimens offered in the rest of Scotland.

She added: “As with any HIS report, it is standard practice that the clinical service involved is invited to review the draft document for factual accuracy before publication.

“The Tayside oncologists were part of a team of medical and non-medical members of staff who submitted comments on the draft report before it was released on April 1.”

The depth of anger felt by senior oncologists at Ninewells Hospital over a report critical of their practices has been laid bare in the dossier received by The Courier yesterday.

Responding to Healthcare Improvement Scotland statements around dosages of chemotherapy drugs delivered on Tayside, they say they are “deeply distressed” by the “factually inaccurate report”.

It is an extraordinary document which also warns the findings “frightened a vulnerable population and undermined their confidence in the health professionals who care for them”.

Medics rely on that trust to be able to properly administer treatment and care.

They are fiercely proud of it and anyone calling into question clinical decision-making must ensure they are on evidentially solid ground.

The other remarkable element of the oncologists’ response is that it has not been made public until now.

The doctors concerned had a right to officially respond to any public perception they had delivered anything other than exemplary care. They have been denied that right and their resultant anger is understandable.

The response is one of several documents which have come to light in this piecemeal manner.

Patients have called for an inquiry. It is time to lay bare the facts of this episode in their entirety.

Picture: Kim Cessford. The report asserted that patients in Tayside were being given lower than standard doses of chemotherapy.

Chief medical officer Dr Catherine Calderwood.