Almost 1,400 patients with either breast or lung cancer died in England in 2014 within a month of being given chemotherapy, according to a study which suggested they suffered harm rather than benefited from the drug treatment.
Those who died within 30 days accounted for a small proportion of the total number given the toxic anti-cancer drugs designed to destroy tumours. Most of the patients were given chemotherapy for palliative care, with the intention of relieving cancer symptoms rather than curing the patient.
But, according to the authors of the study commissioned by Public Health England (PHE), “patients dying within 30 days after beginning treatment [with chemotherapy] are unlikely to have gained the survival or palliative benefits of the treatment, and in view of the side-effects sometimes caused … are more likely to have suffered harm”.
The study, which is published in the Lancet Oncology journal, showed the deaths were spread across the country and not clustered in any one area. However, analysis of the data submitted by the hospitals revealed some had higher death rates than would be expected once the age and condition of the patient had been taken into account. All those hospital trusts have been asked to check their data and investigate whether patients were treated appropriately.
The study is groundbreaking because it is the first time that national data has been gathered together and analysed for 30-day mortality after chemotherapy. It found that a larger proportion of patients die than in the clinical trials carried out by the drug companies. The death rate in trials of drug treatments for lung cancer was 0.8%, but in the present study it is 3%.
“Trials try to exclude high-risk patients,” said Dr Jem Rashbass, cancer lead for PHE and one of the study’s authors. “You are more likely to get a positive answer [about the benefit of the drug] because of the case mix.”
PHE hopes the research will enable hospitals and clinicians to look carefully at who they treat with chemotherapy and, in some cases, make better decisions. There is no suggestion of blame, most people do well on chemotherapy.
“These are judgments,” said Rashbass. “Medicine is greatly informed by hindsight. No doctor tries to give medicine to their patient to kill them but sometimes that balance goes the wrong way. I don’t see this as being bad practice.
“The easiest way not to kill your patients with chemotherapy is not to give it to anyone, and that is clearly wrong.”
There were 569 breast and 720 lung cancer deaths within 30 days of those patients being given chemotherapy for palliative care.
There were 41 breast cancer patients and 53 lung cancer patients who died after chemotherapy intended to cure them. The breast cancer patients were being treated at seven hospital trusts: Burton, Ipswich, Kettering, South Warwickshire, Dorset, Gloucestershire and Coventry and Warwickshire.
The lung cancer patients were being treated at five trusts: Milton Keynes, South Tyneside, Torbay and South Devon, Surrey and Sussex, and the Royal Bournemouth and Christchurch.
Most of the trusts said either that they had made mistakes in the data they sent to PHE or that the patient died of something other than their chemotherapy treatment.
Chemotherapy mortality study could help improve cancer care in England
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