Error reopens wounds of couple’s cancer fight
Pair among nearly 1,000 Ontarians who got watered-down treatment
They were diagnosed just months after they started dating.
She, with breast cancer. He, with a tumour the size of an orange between his heart and lungs.
Their fledgling relationship weathered six months of chemotherapy, nausea and hair loss. In the past year, they took turns playing nurse, trucking each other’s kids to basketball and soccer games. They joined their families, bought a plot of land, built a house. They thought the worst was over.
But Pam Wooder and Greg Lee of Ingersoll, Ont., discovered Thursday they are both now caught up in what health officials are calling one of the worst medication errors they’ve seen. They are among nearly 1,000 Ontario cancer patients who received diluted chemotherapy drugs during their treatment.
“If there is even one little cancer cell left, if it decides to split, could that extra 20 per cent of the drug that was diluted have smoked that last cancer left?”
GREG LEE CANCER PATIENT WHO RECEIVED DILUTED MEDICATION
Next week, Lee, 37, will learn the prognosis of a new lump found growing on his thyroid.
“If there is even one little cancer cell left, if it decides to split, could that extra 20 per cent of the drug that was diluted have smoked that last cancer cell?” Lee wonders.
“Uggh,” says Wooder in a tone of mock exasperation when asked how she’s feeling. “Who gets cancer together? Who gets bad cancer drugs together?”
On Thursday, the Ontario government said it will launch an independent, third-party review of quality assurance in the province’s cancer drug supply chain to safeguard patient care to “prevent incidents like this.”
In Windsor, a $25-million notice of classaction lawsuit was filed with the court against the drug supplier.
Diluted forms of cyclophosphamide, prescribed to both Lee and Wooder at London Health Sciences Centre, and gemcitabine were supplied to four hospitals by Marchese Hospital Solutions. Federal and provincial investigators were at its Mississauga facility, one of three sites, Wednesday to investigate.
The drugs received by the patients were found to be weaker than what was prescribed by as much as 20 per cent.
What does it mean for a patient’s treatment? Those receiving cyclophosphamide have more reason to worry, said a top oncologist.
“When it’s used in situations where the goal of cancer treatment is . . . removing the cancer permanently, the change in dosage would have a greater impact,” said Dr. Malcolm Moore, director of the drug development program at Ontario Cancer Institute/Princess Margaret Hospital.
In those cases, maintaining a precise dose throughout treatment is vital.
Alower dose of gemcitabine, he said, is likely not “clinically significant.”
While much of the information about the case, specifically contracts surrounding the drug supply, preparation and quality-assurance protocols, is being kept secret from the public, those affected directly are getting more details of what may have happened.
Tina Wells, a 44-year-old cancer patient from Kingsville, Ont., received diluted chemotherapy treatments starting in February at Windsor Regional Hospital. She met Thursday with oncologist Dr. John Mathews, she said.
“What I was told was that there’s a 200 ml bag of saline that’s given to the oncology department where they’re supposed to add the chemo. From March 2012 it had been more than 200 ml. There had been an extra teaspoon of fluid which was picked up by a Peterborough technician. So this means 10 to 15 per cent less chemo for patients who were to take the cyclophosphamide,” said Wells.
A media representative for the Windsor hospital said Mathews was meeting patients and unavailable for comment.
Wells said she will be part of the upcoming class-action lawsuit if it goes forward. The notice filed by two law firms — Sutts, Strosberg and Siskinds — names plaintiff Lisa Arlene Hunt, who received a series of chemotherapy treatments at Windsor starting in October 2012.
The notice states: “The defendant breached
“Our concern is that we . . . find out what happened and that we have the right people investigating that.” PREMIER KATHLEEN WYNNE
its duty because it failed to take reasonable steps to ensure that the proper dose of cyclophosphamide or gemcitabine was contained in the bags that it delivered to Windsor Regional Hospital, London Health Sciences Centre, Lakeridge Health and Saint John Regional Hospital for use in cancer treatment.” The claims contained in the notice have yet to be proven in court. An as-yet unnamed third party will investigate the incident, Premier Kathleen Wynne said Thursday. The independent investigation adds to those already underway by Cancer Care Ontario and the Ontario College of Pharmacists, in partnership with Health Canada. “Our concern is that we . . . find out what happened and that we have the right people investigating that,” Wynne said. The probes reflect the complexity of the situation. Parties on all sides are pointing fingers, with Marchese accusing the hospitals of improperly administering the drug and hospitals accusing Marchese of supplying it incorrectly.
It’s unclear whether the responsibility in this case lies with the drug compounder or the hospitals delivering it.
Dr. Carol Sawka, Cancer Care Ontario’s vice-president of clinical programs and quality initiative, said she doesn’t know whether Marchese provided ready-to-use mixtures of the drugs or if additional effort was required by the hospitals to prepare the cocktail before it was given to patients.
“We don’t have all the information now,” Sawka said. “Hospitals have told us that the drugs that were delivered were less than the intended doses.”
As the reviews trudge forward, Wooder, who sells personal care supplies to nursing homes and hospitals, and Lee, who works for a commercial air conditioning company, are looking forward to spring. To bike riding with their four kids, to a new puppy and to fresh, green sod being laid down in June.
“What’s next is we keep our day-to-day going,” Wooder said. With files from Richard J. Brennan and Wendy Gillis