Tayside doctors are still prescribing lower chemo doses to breast cancer patients despite agreeing to follow national guidelines, it has been claimed.
Oncologists were rapped by watchdogs earlier this year for cutting patients’ dosages without their knowledge.
An investigation by a government watchdog found local medics had clashed with counterparts from across the north of Scotland over the strength of docetaxel.
The drug is used to reduce the risk of breast cancer reoccurring, but can cause side-effects such as diminished blood counts.
Tayside docs chose to administer the drug at a 75mg/m2 dose, against recommended practice, believing it to be as effective as a full 100mg/m2 dose without unpleasant side effects.
However, they sought to cover this up in published care guidelines – and didn’t tell patients they were getting a weaker dose.
Figures obtained by the Tele show a 75mg/m2 dosage of docetaxel cost £20.76 per dose.
Administering the full-strength 100mg/m2 dose, in line with best practice across the north of Scotland, would have cost just £3 more – £23.76 each time.
Lee Dennis founded the NHS Tayside Cancer Care Support Group after discovering she was one of 200 patients affected by the decision.
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She said: “Is that the price of a life? £3 is the price of getting rid of cancer, potentially permanently or not permanently. Are they for real?”
After Healthcare Improvement Scotland (HIS) published its report into Tayside in April, the health board vowed to give all patients full-strength doses.
However, letters seen by the Tele suggest oncologists are still pushing weakened regimes – against patients’ wishes.
This is despite medical director Professor Peter Stonebridge’s pledge that patients would get “the same regimes as in the rest of Scotland”.
One woman in her 70s sought a second opinion after consultations at Perth and Ninewells.
The patient said she wanted to try the full-strength regime to give herself the best chance of long-term survival.
However, she claims it was “dictated” to her she would only get the lower dose because of her age.
She only learned details of her situation after requesting copies of the letters sent by a cancer consultant to her GP.
The letter reads: “Given her age, her doses will be capped at 80mg/m2.
“This is important given the recent publication by HIS . . . on the basis of which we have been mandated to offer patients these drugs at 100mg/m2.
“Given her age however, published evidence would suggest that it’s far safer to treat her at the former doses and she is accepting of this today.”
The woman denies this and claims the decision was not justified to her.
She has since started another treatment in Edinburgh at full strength.
She said: “I was expecting to get the standard dose. I was told reduced doses were ‘offered’ but I thought that was as far as it went.
“I said I wanted it to be successful and to try taking the full rate to see if I could tolerate it. I appreciate it’s a toxic chemical and there would be side effects but I wanted to try it. The consultant said no.
“It’s a recommended dose for a reason. I feel it’s very dangerous to offer reduced rates.”
Last month, an independent advisory group convened by the Scottish Government issued 19 recommendations to re-establish public confidence in cancer care at NHS Tayside.
Among its recommendations is an “explicit” need to inform patients whenever they are being offered treatment that varies from nationally accepted norms.
NHS Tayside’s medical director, Professor Peter Stonebridge, said in April that all patients would be offered full-strength chemo doses after the release of a watchdog’s report into its cancer care practices.
In response to the allegations presented by a patient today, the health board said: “The same chemotherapy dosage regimens are offered to patients in Tayside as in the rest of Scotland. This includes offering 100mg of docetaxel.
“Every patient is treated individually and therefore treatments are tailored to the needs of the patient.
“The chemotherapy dosage given to a patient is fully discussed and agreed in partnership with the patient during their face-to-face consultation with their oncologist. The patient gives their consent to the treatment at this meeting.
“Patients are then offered a second consultation with their oncologist prior to the start of their treatment if they want to discuss any further concerns or have additional questions.
“The patient in this case did receive these two consultations with their oncologist to discuss treatment.
“Any patient can also contact their consultant directly at any time should they have any concerns regarding their treatment.”
Dr David Dunlop, senior medical officer for Scotland, reviewed Tayside care following the release of the April report, and found “no evidence of anything other than exemplary practice around consent and communication” in the records he reviewed.
However, his claim that reduced doses of chemotherapy would have not have affected the outcomes of implicated patients was rubbished as “insensitive, dispassionate, inaccurate” by the NHS Tayside Cancer Care Support Group.