Summary
Mr C had surgery for bowel cancer and then started chemotherapy to reduce the risk of his cancer recurring. He suffered significant gastrointestinal side effects from the chemotherapy, including abdominal cramps and diarrhoea. He went to the emergency department at Victoria Hospital but his oncology consultants (cancer specialists) were not told about his visit. A week later, Mr C started to have regular sickness and diarrhoea and he visited his GP twice for treatment. Three days before his second cycle of chemotherapy, Mr C was reviewed by an associate specialist oncologist, who assessed Mr C's diarrhoea as grade 0 (on a scale of zero to five, where grade 5 is the most severe). The oncologist pre-authorised the administration of the drugs at a reduced dosage and made a note that Mr C's side effects should be observed closely. Mr C continued to experience diarrhoea and he reported this to the nurses at the chemotherapy unit when he went to receive the second cycle of chemotherapy. His condition deteriorated over the next few days and NHS 24 referred him to Victoria Hospital, where a scan showed evidence of severe chemotherapy-related inflammation, and possible perforation, of the colon. Mr C's chemotherapy was stopped and he had an operation on his colon, spending five weeks in hospital.
Mr C complained that his symptoms of chemotherapy toxicity were not recognised within a reasonable time and that he should not have been given another cycle of chemotherapy treatment.
I took independent advice from an adviser who specialises in oncology. The adviser said that the symptoms Mr C described amounted to grade 2 or 3 diarrhoea. The board's guidance stated that further treatment should not have been prescribed until the diarrhoea had settled to grade 1 or lower. The adviser found that the toxicity assessment by the associate specialist oncologist was inadequate and that further chemotherapy should not have been prescribed. He also said that when Mr C reported his on-going diarrhoea to nursing staff, they should have asked for medical advice before administering chemotherapy. The adviser said that Mr C should have been able to easily get advice about his problems, for example, from a 24-hour cancer treatment telephone helpline. He commented that the lack of access to a single point of advice about chemotherapy-related problems resulted in poor communication of these problems to the oncology team treating Mr C.
The advice I have received is that Mr C had considerable difficulty accessing medical advice when he developed problems. I found that there were failings at almost every contact Mr C had with health care professionals in relation to the second cycle of chemotherapy and that the system in place to ensure he was treated safely was inadequate. I found that better arrangements were needed to ensure that patients were properly assessed on the day of treatment at the chemotherapy unit, and that the nursing staff must raise any concerns with medical staff. In view of the failings identified, I upheld the complaint and made recommendations.
Redress and recommendations
The Ombudsman recommends that the Board:
- bring the failures to the attention of relevant staff and ensure they are addressed as part of their annual appraisal;
- review the governance arrangements of this unit in light of my findings; and
- apologise to Mr C for the failures my investigation identified.