Decision Report 201302169

Summary

Mrs C, who is an advice worker, complained on behalf of her client (Mr A) who was not satisfied with the care and treatment provided to his late wife (Mrs A) at the Beatson Oncology Centre. Mrs A was diagnosed with local and secondary breast cancer in 2003 and was treated first with chemotherapy (a treatment where medicine is used to kill cancerous cells) although this had little effect. She was then treated successfully with hormonal therapy. In 2006 a new tumour developed and an alternative hormonal treatment was prescribed. Scans in 2007 showed no progression in the secondary cancer but the tumour had increased slightly. The tumour continued to grow slowly and in 2009 Mrs A's hormonal treatment was changed again, the tumour was surgically removed and she was treated with radiotherapy (a treatment using high-energy radiation). Two years later, scans revealed that the cancer had spread to her liver and she started a course of chemotherapy. Mrs A continued to feel unwell and was eventually admitted to the centre suffering from confusion, breathlessness and swollen legs. Staff tried to find the cause of Mrs A's symptoms but she died about two months later.

Our investigation included taking independent advice from three of our advisers - a consultant oncologist (cancer specialist); a palliative care consultant (end of life care specialist); and a senior nurse. We found that the care and treatment provided to Mrs A had been reasonable, appropriate and timely. When her cancer initially failed to respond to chemotherapy the treatment was changed, and this controlled the progression of the disease in the early stages. When a further tumour was found in 2006, appropriate treatment and follow-up was undertaken. Again, when the cancer was found to have spread, appropriate treatment was started to try to address this, although it was unsuccessful. Overall, the advisers were satisfied that the medical and nursing care provided to Mrs A were reasonable.

There were some problems with communication between staff and Mr A and his family, in particular towards the end of Mrs A's life when the family said that she had been put on an informal end of life care pathway similar to the Liverpool Care Pathway (a protocol used to guide staff caring for patients who are nearing the end of their life, by treating symptoms and trying to ensure patients remain comfortable and die with dignity). The advisers, however, found no evidence in the medical records that Mrs A was put on an end of life care pathway, and were satisfied that the care she received towards the end of her life was appropriate, and took account of her needs and symptoms.