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Senior doctors at NHS Tayside have claimed they feel forced to give inferior cancer care to patients against their medical judgement.

Concerns Raised about Inferior Cancer Care

The doctors have raised concerns that they feel forced to give high doses of chemotherapy to patients with breast cancer after the issue was raised by the health watchdog, Healthcare Improvement Scotland (HIS). The review by HIS concluded that lower doses may have made the recurrence of cancer more likely and should be raised. Fourteen breast cancer patients died between December 2016 and last month, when the lower-dose regime was ended.

As a result, NHS Tayside increased its chemotherapy doses after concerns from a health watchdog. More than 300 women had been prescribed 75mg/m2 of docetaxel rather than the standard 100mg/m2. Doctors said that a lower dosage would reduce adverse side-effects, and claimed that the higher dose, administered across the rest of Scotland, was “unacceptably toxic”.

However, the HIS report investigated these claims, and criticised the lack of evidence to support the doctors’ decision.

Oncologists in Tayside have now said that they feared for their careers if they did not sign up to the “second-best” treatment, which required them to provide higher levels of drugs. One consultant recently said, who reported on the issue last week: “We are concerned about it. I suspect some patients will get on OK but we could end up with some suffering excessive detrimental effects. If we think this is the wrong treatment or it is dangerous to provide that level we will let people know that. But ultimately it will be up to patients and we will have to give the option.”

Crawford Reid, a councillor in Perth and Kinross and former non-executive board member of NHS Tayside, said: “This is a highly respected group of clinicians who care deeply about their patients. Each person I approached felt a real sense of injustice.”

“I contacted several ex-colleagues to get some background information about the individuals in question, none of whom I have any knowledge of,” he said.

HIS said that it had convened a panel to speak to NHS Tayside staff including oncologists and oncology clinical leads. A spokesman said: “The recommendations have been accepted by NHS Tayside and the Scottish government, and NHS Tayside is developing an action plan to implement the recommendations.”

Scottish Government Involvement

The Scottish government has commented: “Following concerns raised about variations in treatment compared with other health boards we commissioned HIS to carry out a review of breast cancer treatment in NHS Tayside.

“As a result of its report, the oncologists concerned accepted all the recommendations and agreed to change their practices to bring them in line with other health boards.

“In advance of the HIS report the Scottish government also convened a multidisciplinary clinical immediate response group to produce a risk assessment of the impact of variations in clinical practice. The risk assessment was published last week.”

Additionally, it has been reported that a team of specialists from the Royal College of Physicians of London will visit Tayside later this month to form their own opinions.

A Public Inquiry

However, a spokeswoman for the NHS Tayside Cancer Care Support Group confirmed it is considering launching a petition for a full public inquiry.

She said: “We await further reports from the RCP and the GMC. Once these become available for scrutiny, it may be that all concerns will have been addressed and rectified.”

“Failing that, we may petition for a full public inquiry where all evidence and data can be thoroughly examined.”

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