Lower chemo doses given across NHS Tayside caused increased risk of cancer returning

An independent report into lower dosages of chemotherapy given to breast cancer patients across the NHS Tayside region has found the chance of cancer returning was increased by 1-2%.

The review, which was commissioned by the Chief Medical Officer and Chief Pharmaceutical Officer, found around one patient each year may have been affected.

It emerged earlier this month oncologists had treated 300 women with breast cancer with a lower dose of drugs than in the rest of Scotland without their knowledge, between December 2016 and March 2019, in an attempt to reduce side effects.

14 of those women have since died, and the health board says it will investigate the circumstances surrounding their deaths.

The overall assessment of the increased risk of recurrence within that group is extremely difficult to quantify but probably of the order of 1-2%.

The report says there is a chance some women were under-treated as a result of the decision to administer lower doses of chemotherapy drugs.

It adds: "There is a broad range of doses and regimens within adjuvant breast cancer treatment that have been tested in many clinical trials.

"Whilst the NHS Tayside approach may be within the range of doses tested within these trials...there may be a proportion of patients who are being undertreated, and are disadvantaged by not being offered the higher doses."

Responding to the publication of the independent review group report into variations in clinical practice for breast cancer in NHS Tayside, Chief Medical Officer Dr Catherine Calderwood said: “This report looks closely at the level of risk to women as a result of the different clinical practice in treating breast cancer in NHS Tayside.

"It concludes that the risk is very small, with the chance of a negative impact estimated at around 1%.

"However, I absolutely recognise that current and former patients, and their families, may be concerned and have questions with regards to their treatment.

“It is important that anyone who has concerns about their treatment speaks with their oncologist. NHS Tayside has been in contact with all patients affected to offer them an appointment with an oncologist.

"All but 13 of those who want to take up the offer of an appointment have already been booked in and the board is waiting to hear back from the 13 outstanding patients.

“The Scottish Government welcomes NHS Tayside’s acceptance of all of the recommendations of the previous Healthcare Improvement Scotland (HIS) report.

"The board is now developing an action plan to implement these urgently, and is also considering the recommendations of the Immediate Response Group report that has been published today.

"The key change is that the breast cancer chemotherapy dose regime is being adjusted to make sure patients are offered the same level of treatment as the rest of Scotland.

“I have also commissioned an expert group to fully consider all the individual recommendations. It is important that this work is completed in good time, and I expect them to present their findings in June to coincide with expected resolution of the issues highlighted in the HIS Report."

Professor Peter Stonebridge, Acting Medical Director NHS Tayside said: “We fully accept the findings of the Immediate Response Group (IRG) report which was commissioned by the Chief Medical Officer and the Chief Pharmaceutical Officer.

“We have taken immediate action in response to the IRG report and the Healthcare Improvement Scotland (HIS) Report which was published earlier this month.

“The key change is that we have adjusted the breast cancer chemotherapy dose regime to make sure patients in Tayside are offered the same as those in the rest of Scotland. We will also be offering Oncotype DX testing to eligible patients.

“Patients and their families should be assured that we are taking this issue extremely seriously and putting in place all the necessary changes to ensure we provide a high-quality breast cancer service in Tayside."