The use of chemotherapy in England is being scrutinised this week after a study by Public Health England (PHE) found that almost  1,400 patients with either breast or lung cancer died in England in 2014 within a month of being given chemotherapy, suggesting they suffered harm, rather than benefited, from being given chemotherapy.

It's important to realise that the individuals who died within 30 days of starting chemo only accounted for a very small proportion of the total number of people receiving chemotherapy and that most of the patients were given chemotherapy for palliative care, with the intention of relieving cancer symptoms rather than curing the patient. However, the authors of the study stated that “patients dying within 30 days after beginning treatment [with chemotherapy] are unlikely to have gained the survival or palliative benefits of the treatment, and in view of the side-effects sometimes caused ... are more likely to have suffered harm”.

On further analysis of the data submitted by hospitals for the PHE study, it was revealed that certain hospitals had higher death rates than others, even when taking into account the age and condition of the patients. PHE has alerted the relevant hospitals and they are now investigating why this discrepancy in death rates exists and whether patients were treated appropriately.   

PHE hopes the study will enable hospitals and clinicians to look carefully at who they treat with chemotherapy and, in some cases, make better decisions. There is no suggestion of blame, most people do well on chemotherapy.

“These are judgments,” said Rashbass. “Medicine is greatly informed by hindsight. No doctor tries to give medicine to their patient to kill them but sometimes that balance goes the wrong way. I don’t see this as being bad practice.

“The easiest way not to kill your patients with chemotherapy is not to give it to anyone, and that is clearly wrong.”
 

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