The uncertainty consequences of delay in diagnosis of cancer
I read with interest recent medical literature, reporting on research at Johns Hopkins, emphasising the role of a 3rd factor in cancer incidence.
Debate has traditionally focussed on the ‘environmental -v- hereditary’ nature of many cancers. New research, as reported, has confirmed that ‘luck,’ bad or otherwise, appears to be an even more important factor. Random DNA mutations during cell division have been found to explain 2/3 of cancers in adults.
Such research findings, emphasise the role of early detection in cancer care, given the unavoidability of luck, one way or another.
Apart from in cancer’s initial occurrence, several recent cases we have/are handling have emphasised the ‘luck’ element, not just in whether cancer arises in the first place, but additionally in its response to treatment and recurrence.
Sadly, at any time we handle 10 or more cases involving inappropriate delay in diagnosis of cancers. The harm caused by such delay is often the growth and maturation/progression of the ‘missed cancer,’ often most importantly impacting on the statistical probability of such cancer responding to treatment – or recurring.
A couple of cases we have looked at in the last year have emphasised that whilst statistical information, based on staging of cancer at diagnosis, is often the best method for assessing the effect of an inappropriate delay in diagnosis and treatment, it needs to be remembered that individuals may or may not conform to such statistical predictors.
In the first case, given the type of cancer and its very early staging, statistically, our client should have had a very good chance of survival + so the delay of 12 months in diagnosis/treatment should not have caused significant harm. Sadly, to the contrary, within months of engaging us, our client was found to have extensive metastatic spread and her outlook now is grim. From a claim’s perspective, our independent oncologist confirmed that knowing what we know about the aggression of the cancer cells in this unfortunate patient, it remains unlikely that the 12 month delay made any difference: even with diagnosis 12 months earlier, it is likely her cancer would/had spread.
In a second case, the exact opposite occurred. The type and staging of cancer at diagnosis was advanced and likely to be aggressive, with a resulting poor outlook for our client. In contrast, diagnosis 2+ years earlier, at a significantly less advanced stage on statistical grounds should have resulted in a far better outlook. On the other hand, our client has [thankfully] already survived 3.5+ years since diagnosis, without evidence of recurrence. Our independent oncologist considered that in such scenario, again, knowing what we do, it is unlikely the delay in diagnosis has altered the client’s outlook. Given the type of cancer, 3.5+ years without recurrence, put him in an excellent category + it appeared he is in the small statistical group defying the overall poor outlook from his stage of disease. Great news for our client (though not for his claim: though I know which he prefers!).
All goes to show that these types of case, which are sadly reasonably common, require considerable work-up, not only to evaluate whether harm has followed any inappropriate (negligently caused) delay in diagnosis/treatment on a ‘population basis’ but also on an ‘individual basis.’