LUNG CANCER MEDICAL NEGLIGENCE FAILURE TO DIAGNOSE EARLY

John Whelan Solicitor with specialist expertise in Lung Cancer Medical Negligence gives an example of a case of failure to diagnose lung cancer early.    

Case Example: Failure to Diagnose Lung Cancer Early

A case involving the failure to diagnose lung cancer early which resulted in a significantly worse outcome.  A Patient with a history of smoking and chronic cough, presented to his GP with complaints of persistent coughing and occasional shortness of breath that had worsened over the past 6 months. He also reported feeling more tired than usual and had lost about 5kg unintentionally.

Initial Assessment:

1. The Patient was seen for a routine annual check-up, and his GP noted a smoking history and symptoms of coughing and tiredness.
2. The GP was aware of the Patients high risk for lung cancer due to the smoking history but attributed the symptoms to more benign causes like chronic bronchitis or a viral respiratory infection.
3. The GP did not recommend imaging tests, such as a chest Xray or CT scan, nor did the GP suggest a referral to a pulmonologist at that time.
4. The Patient was prescribed cough medicine and advised to follow up if the symptoms did not improve.

Follow-Up and Delay in Diagnosis:

1. Continued Symptoms: Over the next several months, the Patients cough became more persistent and productive, and the shortness of breath worsened, particularly with physical exertion. However, the Patient did not return to his GP immediately, believing that the symptoms were due to chronic smoking and respiratory irritation.
2. Failure to Investigate: At the follow-up visit, 9 months after the initial presentation, the GP still did not order a chest Xray or CT scan, despite the Patients continued symptoms and the high risk profile for lung cancer. The GP assumed that the symptoms were related to chronic obstructive pulmonary disease (COPD), of which the Patients had a history, rather than considering the possibility of lung cancer.
3. Symptom Worsening: As time passed, the Patient developed additional symptoms, including persistent chest pain and hoarseness. When the Patient returned to the office for further evaluation, the GP still did not immediately consider lung cancer as a possibility, assuming these symptoms were related to respiratory infections or COPD flare ups.
4. Delayed Imaging: It was only after the Patient requested a chest X-ray due to increasing discomfort and a sense of worsening symptoms that the GP reluctantly ordered the test, nearly a year after the patient’s initial visit. The chest Xray revealed a mass in the right lung. A CT scan was ordered to further evaluate the lesion, and the results showed that the mass was consistent with lung cancer.

Diagnosis:

1. After further imaging and a biopsy, the Patient was diagnosed with non small cell lung cancer at an advanced stage, which had already spread to the lymph nodes and liver.
2. The cancer was no longer amenable to curative treatment such as surgery or radiation. The Patient was referred for chemotherapy and palliative care.

Outcome of the Case:

1. Due to the delay in diagnosis, the cancer had progressed significantly by the time it was discovered. Despite undergoing chemotherapy, the Patient had a poor prognosis and was not eligible for aggressive treatments that could have improved the Patients quality of life or extended the Patients survival.
2. The delay in diagnosis and the advanced stage of the cancer meant that the treatment options were limited, and the chances for long term survival were significantly reduced.

Important Points of the Case:

1. Failure to Screen and Investigate Symptoms: The Patient’s symptoms, particularly the chronic cough and weight loss, were indicative of a serious underlying condition, but the GP did not prioritise early investigation due to assumptions about the cause being related to COPD or a chronic infection. Given the Patients smoking history, a chest Xray or CT scan should have been ordered earlier.
2. Delayed Diagnosis of Lung Cancer: The lack of timely imaging delayed the diagnosis of lung cancer. By the time the diagnosis was made, the cancer had already spread, making it less treatable and leading to a significantly worse outcome.
3. Failure to Follow up on Risk Factors: the Patient smoking history placed the Patient at a high risk for lung cancer, and this risk factor should have prompted more vigilant monitoring and earlier testing for lung cancer.

For more detailed insights into how the Patient Safety Act 2023 impacts you and how Whelan Law can support you, please visit our Lung Cancer Medical Negligence https://www.whelanlaw.ie/news/rising-lung-cancer-medical-negligence-claims-a-reflection-of-modern-medicine/