Brain cancer patients in Coventry were routinely prescribed extended, non-standard courses of chemotherapy, leading to some being misdiagnosed and exposed to serious risks and harm, according to a review. The Royal College of Physicians (RCP) is currently investigating 20 cases where patients were given the drug temozolomide (TMZ) for long periods, despite what the RCP described as "little or no evidence of benefit."
Preliminary findings of the review, which were leaked to the BBC, stated that staff failings amounted to a "betrayal of patient trust." University Hospitals Coventry and Warwickshire (UHCW) NHS Trust has stated that measures have been implemented "to ensure more robust oversight of the prescription and use of TMZ and ensure patient safety."
Guidelines typically recommend TMZ be taken for six cycles, usually over six months, following radiotherapy. However, some patients reported receiving the treatment for many years, with one case lasting 16 years. Side effects associated with TMZ include muscle weakness, memory issues, and in rare instances, secondary cancers and liver damage.
The review found "scant evidence" of understanding and documentation of the drug's risks. In one instance, a patient received over 100 cycles of TMZ before doctors identified a different, less aggressive tumour type than initially believed. This patient later developed acute myeloid leukaemia after showing signs of bone marrow suppression.
The report criticised a consultant, referred to as Dr Y, who did not participate in the review, and a former clinical nurse specialist, Mr N, whose working relationship with Dr Y was described as "very unusual." The review team considered that Mr N practised outside of recognised standards, including failing to ensure accurate information and informed consent for patients. The report also questioned why oncology pharmacy teams did not challenge patients receiving oral chemotherapy continuously for 10 to 15 years.