Hospital failed to refer patient with rare cancer to a specialist team

What happened

Mrs K was diagnosed with a sarcoma, a rare type of cancer, in early summer 2011. The consultant oncologist in charge of her care started radiotherapy treatment. He did not seek any specialist advice about what treatment Mrs K should have. In early autumn 2011 Mrs K was discharged from the oncology department and staff told her she would have follow–up appointments at a different department.

In early 2012 Mrs K started to experience leg pain and loss of feeling in her buttocks. A scan showed she had a cancerous tumour on her lower spine. She had surgery to remove the tumour, although it could not be completely removed, and she also had radiotherapy.

The next month, Mrs K asked to be referred to a specialist cancer hospital, but she was told she would be referred to the sarcoma multidisciplinary team at a different specialist centre in another area. Mrs K asked again to be referred to the specialist cancer hospital, and told the hospital she had found out she should have been referred to a specialist sarcoma centre when she was first diagnosed with a sarcoma.

In spring 2012 Mrs K had a scan that showed the cancer had spread to her lungs and possibly her liver. Mrs K was referred to the specialist cancer hospital and had the rest of her treatment there. She died in summer 2013.

What we found

We partly upheld this complaint. The Trust should have sought specialist advice from a sarcoma multidisciplinary team about Mrs K's treatment when her cancer was first diagnosed. This would also have given Mrs K access to a sarcoma key worker (nurse) and her Family would have been able to discuss in more detail the implications of her diagnosis and the outlook for her. The opportunity to explore options for any sarcoma–specific clinical trials was lost. Trust staff misjudged the severity of Mrs K's cancer at first, but this did not affect the treatment she received.

There are variations in clinical practice about whether to give radiotherapy in cases of this type of sarcoma. We could not say that the decision to give radiotherapy in Mrs K's case was a failing in her care. There was no evidence to suggest Mrs K would have received chemotherapy if she had been referred to a sarcoma multidisciplinary team.

There was no evidence that Mrs K was given the option of being referred to a specialist cancer hospital. She was also not given a written care plan.

Putting it right

The Trust apologised to Mr K for the faults in his wife's care and paid him £1,000 compensation to recognise the unnecessary distress caused to him, his wife and Family by the failings. It also produced an action plan describing what it had done to make sure it learnt lessons from the faults we had identified.