The Royal College of Physicians (London) has been giving assistance to NHS Tayside as part of a review into the health board’s breast cancer treatment.
An invited service review (ISR) of NHS Tayside’s oncology services by the college began yesterday (Monday, April 29) and will continue today.
Its findings will be based on interviews with key individuals and background documentation.
A review was called after concerns were aired by a whistle-blower about breast cancer patients receiving lower than the recommended dose of chemotherapy, and a government report said this was given to all patients.
The report says: “Doses of epirubicin and docetaxel in the DECT-T regimen were reduced by 25 per cent in the adjuvant and neo-adjuvant treatment of breast cancer patients in NHS Tayside in 2016 (initially to 75mg/m2 for docetaxel but later to 80mg/m2).”
Records revealed 304 breast cancer patients were identified from December 1 2016 to March 31 2019 - 14 of these patients have since died.
However, doctors have spoken out saying they acted in the patients’ best interests as they believed the higher dose of 100mg/m2 of docetaxel was “unacceptably toxic”.
It has also emerged that not all of the 304 patients were given the drug docetaxel as part of their treatment.
NHS Tayside’s chairman John Brown has assured the board they had immediately responded to the recommendations made to the health board following reports by both Healthcare Improvement Scotland (HIS) and the Immediate Review Group (IRG).
The IRG’s report said: “Whilst the decision to reduce doses in 2016 was taken in the best interests of patients, and based on an audit of toxicity, this decision lacked robust challenge or consultation.
“It reflected a unilateral decision to adopt practice which was judged by the IRG as being outwith best current practice, and close to being unacceptable.
“The estimate of harm is judged to be in the order of an increased risk of recurrence for one patient per year in NHS Tayside.”
The health board has now brought its breast cancer chemotherapy doses in line with other Scottish health boards and Oncotype DX testing (predictive molecular testing) is being offered to appropriate patients.
NHS Tayside has contacted all of the breast cancer patients affected, offering them a clinic appointment with an oncologist.
A spokesperson for NHS Tayside said: “We were aware that patients may not know the details of their chemotherapy regime and needed to be given the opportunity to discuss their individual care with an oncologist.
“Having taken advice from the chairman of the chief medical officer’s expert panel and in line with our duty of candour, it was thought absolutely necessary to contact all patients and offer them an appointment with an oncologist to ensure everyone was fully informed about their care.”
All families of those who have since died have also been contacted and offered an appointment with Dr David Dunlop, senior medical officer for cancer with the Scottish Government, who has reviewed their relative’s case notes.
NHS Tayside’s chief executive Grant Archibald said he and acting medical director Professor Peter Stonebridge and nurse director Gillian Costello were working closely with the oncology team to offer support and rebuild confidence both within the team and with the public.
