HSIB Publishes Investigation of Missed Detection of Lung Cancer
According to the NHS each year around 47,000 people in the UK are diagnosed with lung cancer. This is the third most common cancer but actually accounts for the most deaths. The UK falls behind its European counterparts in terms of the five-year survival rate following diagnosis.
A recent investigation undertaken by the Healthcare Safety Investigation Branch (HSIB) has identified a number of problems in diagnosing lung cancer in England which may go some way in explaining these problems. It has made three key recommendations:
- For NHS England and NHS Improvement to work with researchers to explore the possibility of greater utilisation of CT scans.
- For NICE to consider and amend their guidelines in relation to safety netting advice provided by healthcare practitioners.
- For NHSX to work with relevant other institutions such as the Royal College of Radiologists to develop further guidance to assist with the identification of lung cancer.
Lung cancer can be difficult to detect and diagnose given that the symptoms often mirror other respiratory illnesses. Around two thirds of those affected are diagnosed at a late stage when the disease is no longer curable.
The difficulties associated with this type of cancer will almost certainly have been compounded by Covid 19 with estimates suggesting that the impact of this could lead to an additional 1372 deaths (according to the United Kingdom Lung Cancer Coalition, 2020). This may be due to a combination of patients being reluctant to seek medical attention, overlapping symptoms meaning appropriate referrals are not made and significant backlogs in the NHS service.
Investigations will often start with an x-ray but concerningly research shows that one in five cases of lung cancer are missed on x-ray. CT scanning can be more precise but is not very widely used in England. There is currently no clear consensus as to whether CT scans should replace x-rays for initial diagnosis and the HSIB report suggests further research is required to determine whether this would be cost effective.
The HSIB report identified a number of reasons for missed lung cancer following an x-ray. These can be summarised as follows:
- Observer error: where either the lesion is not visible on the x-ray due to a scanning error, or the person reviewing the x-ray does not detect the lesion or the lesion is detected but interpreted as normal.
- Lesion characteristics: where the position or size of the lesion makes it more difficult to detect on an x-ray.
- Technical considerations: where the image quality and patient positioning or movement makes the lesion more difficult to detect.
HSIB also identified that difficulties arise as medical professionals may be falsely reassured by normal findings on the x-ray. This can mean that further referrals are not made despite ongoing or even deteriorating symptoms. Accordingly, HSIB has identified that better safety netting needs to be in place to ensure that further investigations are arranged where there are persisting problems.
Whilst the NHS provides an invaluable service in diagnosing and treating cancer the investigation has identified a number of problems which need to be addressed in order to maximise the chances of providing curative treatment.
The impact of a missed or delayed diagnosis can be catastrophic. For some people this may mean that additional or more invasive treatment is required and for others it may mean that curative treatment is no longer possible. If the diagnosis was missed due to substandard care this may be an instance of medical negligence. This could include a radiographer failing to detect a lesion when they ought to have done or a GP failing to arrange further investigations in light of continuing or worsening symptoms.
Pursuing a medical negligence claim can result in a compensation payment which will help you to recover any financial losses and rebuild your life. It can also provide support for your loved ones if the delay has led to a reduction in life expectancy. The investigation process can also lead to internal reviews and improvements which may prevent further missed diagnoses in the future.
If you or a loved one have suffered due to delayed treatment, you may be entitled to make a claim for compensation. Contact our team of medical negligence experts today on 033 3344 9600 or simply email [email protected] with your request.
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