Have Scotland’s blood cancer patients had their lives cut short?

Have Scotland’s blood cancer patients had their lives cut short?

by Jonathan Stanley
article from Monday 3, August, 2020

ONE CASUALTY of Humza Yousaf's obsession with limiting criticism of his government was the use of emergency powers to make it difficult to gather data from public bodies using Freedom of Information Act requests. Even though the extension of the minimum response time of Freedom of Information requests was ultimately defeated at Holyrood the SNP Government made clear its view that providing transparency was not a priority for public administrators.

While still not in possession of all the data I requested almost three months ago I am, not surprisingly, only now finally in a position to report on concerns originally raised to me by a fellow doctor working in England. Covid-19 has been the single largest disruptor to clinical care I have ever known. Its arrival forced the NHS in Scotland and other public bodies to make tough and rapid decisions that would compromise the care of sick patients.

One group that was flagged to me was blood cancer patients, that is those suffering from leukaemia and lymphoma. I have focused on acute blood cancers because their nature means even short term disruption to their treatment could have major repercussions. 

My Freedom of Information request to NHS trusts have in some circumstances been delayed, required appeals to find accurate data and in one case no response has been received at all, while another remains in appeal. This variation is for exactly the same dataset request despite my insistence such data was essential to public policy making in such a period of rapid change.

I can now confirm that at least 100 patients have had part of their cancer treatment delayed due to Covid-19. This treatment is in the form of an injectable monoclonal antibody to help keep these cancers in remission, that is, keep them at bay once treated with chemotherapy. 

Such patients are at high risk from dying from Covid-19. They were included in the group of very high risk patients requiring shielding by the then CMO Catherine Calderwood. The National Institute of Clinical Excellence has issued guidance for physicians in England to consider suspending antibody treatment during this crisis due to the need to attend hospital for injections. 

"These interim treatment regimens are based on clinical opinion from members of the Chemotherapy Clinical Reference Group and specialised services cancer pharmacists and endorsed by NHS England and NHS Improvement. Each interim treatment changed has been clinically assessed against the following criteria: a) the treatment is less immunosuppressive and thereby mitigates a patient’s likelihood of contracting COVID-19 or becoming seriously ill from COVID-19 or b) the treatment can be administered at home or in a setting that reduces the patient’s exposure to COVID-19 or c) the treatment is less resource intensive and makes better use of clinical capacity and d) the treatment is feasible; that is, it is not likely to require significant service change or additional training and e) there is likely to be adequate capacity in the relevant sector (such as home care providers) to deliver the treatment.

The responsibility for using these interim treatment regimens lies entirely with the prescribing clinician, who must discuss the risks and benefits of interim treatment regimens with individual patients, their families and carers. All patients who start on an interim treatment during the COVID-19 pandemic should be allowed to continue the treatment until they and their clinician jointly decide it is appropriate to stop or to switch to a different treatment. The interim treatment changes are for an initial 3-month period only, starting 23 April 2020, and to address the COVID-19 pandemic. Treatment regimens will revert to the standard commissioned position after this period unless otherwise stated."

It is clear it remains the decision of the prescribing physician though this means there must always be a discussion with the patient as fits their own personal best interests and preferences. 

Accordingly, these are the questions I would ask the Cabinet Secretary for Health but given Scottish government policy seems to be to reduce the amount of questions it is prepared to answer I will ask them here:

1. Has suspension of antibody treatment for blood cancers been a government directive or has each delay been agreed between the patient and attending physician?

2. What strategies were pursued to offer treatment away from busy hospitals? Was the use of private clinics or administration at home considered as a well of treating shielded patients?

3. When were delays to antibody treatment instigated and when will normal treatment be restarted?

4. Given much lower case numbers of Covid-19 in the past two months – and the lack of critical care demand from Covid-19 compared to initial expectations – has the policy of treatment delay been reviewed formally and when was that review?

Cancer care is not easy and this crisis has created immense and novel challenges to blood cancers. It is only right we have access to clinical data in as fast a time as possible when appraising changes to treatment strategies in a rapidly moving environment. 

Two months is a long time in cancer treatment and we have to have the confidence these decisions are always the best ones available at the time.

Dr Jonathan Stanley



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