Cancer death sparks review

AN URGENT review of NHS Fife’s radiology procedures is to take place after its board failed to diagnose a patient’s lung cancer for five months.

The patient, known only as Mrs C, died only three weeks after being diagnosed with the disease, which by that time had spread to her bones, kidney, lung and brain.

NHS Fife has apologised to Mrs C’s widower, who brought his concerns about the delay in diagnosis to the attention of the Scottish Public Services Ombudsman, who upheld his complaints.

Mr C complained an X-ray taken more than five months before his wife’s eventual diagnosis had not been read properly.

He said this had misled clinicians into dismissing lung cancer as a diagnosis, despite other serious and persistent problems.

This, he believed left his late wife with inappropriate treatment and pain relief in the final months of her life.

He also felt this had possibly reduced her life expectancy as her cancer had not been discovered until it was too late for treatment.

Mrs C, who was a non-smoker and therefore deemed to be at low risk of lung cancer, developed a persistent cough. She was referred by her GP for a chest X-ray which was taken in January last year and reported to be normal.

However, her symptoms persisted and changed and Mrs C went on to have X-rays on her pelvis, hip and lumbar spine two months later.

However, her pain continued and a numbness in her shoulder emerged.

A respiratory consultant said she had a viral infection.

After an X-ray of her shoulder in June she was diagnosed with tendonitis.

However, later that month an orthopaedic registrar recognised several concerning warning signs and referred Mrs C for urgent tests and an MRI scan.

Two days later she was admitted to hospital and tests revealed lung cancer and Mrs C died less than three weeks later.

Ombudsman Jim Martin accepted independent advice that the initial X-ray had shown subtle abnormalities which should have been identif ied by the radiologist at the time and in subsequent reviews by other clinicians.

As a non-smoker and alongside a reportedly normal chest X-ray, this had “misled” clinicians to discount a possible lung cancer diagnosis.

Mr Martin said subsequent X-rays had shown “increasingly clear evidence of a serious underlying condition which should have been identified”.

He added: “Several further opportunities to diagnose lung cancer sooner were missed.

“Even if the diagnosis had come after the X-ray in March, which showed clear signs of the disease in Mrs C’s pelvis, it would then have been possible to alleviate the severe and distressing pain she suffered over the next three months,” he said.

Mr Martin made three recommendations to NHS Fife:

To highlight to clinical staff the need to review X-rays as well as X-ray reports when diagnosing patients;

To apologise to Mr C for the failings identified in his report;

To arrange an external review of their radiology practice in consultation with the Royal College of Radiologists.

NHS Fife executive director of nursing Dr Scott McLean took the opportunity to apologise to Mr C. He added: “We accept the recommendations made by the Scottish Public Services Ombudsman and these are being taken forward.”