A LUNG cancer patient may have survived if a doctor had not mistaken his chronic cough for asthma, a watchdog has said.
NHS Fife has been rapped over "significant and serious failures" in the man's care, including his removal from an urgent cancer referral pathway despite abnormal X-ray and CT scan results and his history of smoking and asbestos exposure which put him at high risk of lung cancer.
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Despite "significant changes" to his chest and lungs, the respiratory consultant diagnosed asthma and said no further tests were required.
The cancer spread causing "extreme pain" to the patient, known only as Mr C, and he died less than a year later.
An investigation by the Scottish Public Services Ombudsman (SPSO) heard how Mr C was first referred to the Victoria Hospital in Kirkcaldy in September 2014 complaining of a chronic cough and breathlessness which his GP feared could be lung cancer. He underwent an X-ray in September and CT scan in October.
A independent expert told the SPSO that Mr C's results combined with his chronic cough, being a former smoker and having been heavily exposed to asbestos should have triggered a biopsy. If lung cancer had been detected between October and November 2014 - instead of June 2015 - it may have been treatable, the SPSO was told.
The report states: "As a best case scenario, thoracic surgery though complex could have been considered and possibly may have been curative, although unlikely.
"While combined chemotherapy-radiotherapy was unlikely to be curative it was probable that with this treatment Mr C's prognosis could have been considerably better with an improved survival time."
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The SPSO was also advised that despite the asthma diagnosis, no lung function tests were requested to confirm it.
The advisor added that it breached national guidelines that Mr C, as a "complex and high risk" case, was removed by the consultant respiratory physician from the cancer referral pathway without his case being reviewed first at a meeting of the health board's lung cancer specialists.
In light of these findings, an independent review into NHS Fife's lung cancer service is to be carried out to determine "the reason for and the frequency with which patients are removed from the referral pathway without discussion".
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The SPSO also found "serious failings" in Mr C's nursing care, including errors with prescriptions and record-keeping. His palliative care nurse visited him only once between his diagnosis with terminal cancer in June 2015 and his death three months later, leaving his family feeling "abandoned at an incredibly difficult time".
NHS Fife Chief Executive, Paul Hawkins, said: “The death of a loved one is a traumatic experience for any family and where there are concerns over quality of care this undoubtedly compounds any distress. As such, NHS Fife has formally apologised to Mrs C and I would like to take this opportunity to reiterate that apology.
“We note the Ombudsman’s report and accept the recommendations made within it. As a result, a number of systems and processes within the lung cancer service have been addressed to avoid any similar instances arising in future.”
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