‘Under-dose’ for patients no mistake
CLAIMS Toowoomba Hospital had been involved in a “cover up” involving giving terminally ill cancer patients a low dose of chemotherapy were yesterday denied by the Department of Health.
While the department admitted 10 palliative-care patients suffering from small cell lung cancer had been treated using a dosage of chemotherapy lower than the national standard, Minister for Health Cameron Dick said clinicians had a professional obligation to adjust chemotherapy treatments.
“Palliative-care patients treated in Toowoomba Hospital for small cell lung cancer between 2009 and 2017 received a dosage of chemotherapy drugs lower than the recommended protocol under the national protocol,” he said.
“The Toowoomba protocol was set locally following expert clinical consideration. There was no policy or regulatory obligation to use the national protocol.
“We are reviewing other palliative-care patients to see if the national protocol is suitable or may warrant reviewing itself.”
Mr Dick said families of the 10 patients treated, nine of who had since died, were being contacted yesterday. Toowoomba Hospital has since reverted to the national protocol.
He said the Department of Health was told of the issue on May 25, with an incident review panel - led by cancer specialist Liz Kenny convened on May 26. A further independent verification review is being undertaken by lung cancer experts with findings to be released.
The panel revealed 47 patients had been treated outside the national protocol, used by every other hospital in Queensland. However 37 of those were unable to tolerate even the lower dose of chemotherapy, with the remaining 10 showing an improvement using the Toowoomba protocol.
Department of Health Director Deputy-General Dr John Wakefield said those 37 patients either had a dose reduction because they suffered toxicity or they had delays to their cycles of chemotherapy or both.
“As a consequence of the clinical advice, those patients had no consequence at all related to the administration of the Toowoomba protocol,” he said.
“The other 10 patients had tolerated the chemotherapy in the dosage in which it was given and they actually had optimised treatment.”
Dr Wakefield explained palliative chemotherapy was very different to curative chemotherapy, which had the goal of killing the cancer completely.
“The goal is not curative. The patient is going to die of this cancer and in this particular type of cancer, small cell cancer of the lung, it’s very aggressive, very advanced at diagnosis and life expectancy is less than 12 months,” he said.
“The goal of palliative chemotherapy, if the patient accepts palliative chemotherapy and not all patients want it, is simply to provide them with the best possible quality of life in the time they have left.”
Dr Wakefield said it was a balancing act for doctors to make sure the patient’s life was not intolerable but better managed their symptoms.
He said the decision about the dosages was made in 2009 and was not a mistake or an error of putting that protocol into the electronic prescribing systems, after Queensland moved from paper-based protocols to the electronic system.
“It was a very well-intentioned decision, informed decision, of the clinicians at the time who viewed the protocol from New South Wales as being too aggressive,” he said.
The New South Wales protocol, the eviQ protocol, was introduced nationally in 2014.
Darling Downs Hospital and Health Service Board Chair Mike Horan said the families of the patients were not told when the issue was uncovered because it would have caused them unnecessary grief.
“Because the review had shown clearly there was no harm, there were no mistakes and in fact the actual results of this palliative treatment had exceeded what is the standard level of achievement that is desired out of that particular treatment,” he said.
Opposition health spokesman John-Paul Langbroek said the incident was in fact a clear pattern of cover-up from the State Government and said an incorrect dosage of chemotherapy could have increased the speed at which the patients died.
Any families who are concerned or need support should contact Cancer Council Queensland on 13 11 20.