Dosage problem kept from cancer patients
Ethics questioned after agency fails to inform 175 people
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Hey there, time traveller!
This article was published 17/08/2018 (2050 days ago), so information in it may no longer be current.
Dozens of Manitoba cancer patients were not notified by their physicians that they were receiving a lower dosage of highly concentrated intravenous medication than they were prescribed due to issues with the way the drugs were administered.
An Ontario nurse alerted Cancer Care Ontario in June about the inconsistent way cancer treatment drugs Pembrolizumab, Nivolumab and Panitumumab were being administered, in which small amounts were left behind in IV tubes after treatments. The agency passed that information along to hospitals in Ontario and their counterparts across the country, as well as Health Canada.
CancerCare Manitoba chose not to share that information with Manitobans who were affected.
“In our estimation, this was not something our patients needed to be alarmed about,” said Dr. Piotr Czaykowski, CancerCare Manitoba’s chief medical officer, on Friday. He’d been notified about the concern one week earlier.
The agency determined 175 people were in the at-risk group: people who may have been underdosed during the past two years, since the drugs were first introduced in Manitoba.
The drugs are often used to treat patients in the late stages of cancer, such as advanced colon or kidney cancer or melanoma.
Some Manitobans received 15 per cent less than their prescribed dosage for these drugs, Czaykowski said.
Withholding that information from patients was an ethical and medical mistake, said Arthur Schafer, founder of the Centre for Professional and Applied Ethics at the University of Manitoba.
“The idea that CancerCare Manitoba knows best and is entitled to titrate information the way physicians titrate drugs is, I think, unacceptably paternalistic,” said Schafer, who has worked as a medical ethics consultant in Winnipeg.
Patients are entitled to know when there has been a screw-up that could potentially affect their health, he said, adding that even a missing trace of such potent drugs could impact their usefulness.
“A better public health policy would be one that stresses openness, honesty and transparency,” Schafer said.
The Canadian Medical Protective Association’s guidelines on disclosure state health-care providers have an ethical, professional, and legal obligation to disclose harm as a result of treatment. However, Czaykowski said it’s hard to know if any underdosed patients didn’t benefit from the drug because of all the variables in patient responses.
The agency didn’t think the underdosing amount was “meaningful,” he said.
“For this class of drugs, and for many drugs, we routinely will accept a variance from the prescribed dose of 10 per cent, just because of the way drugs are packaged in vials and vial sizes,” he said.
Ontario hospitals identified 1,000 patients who likely didn’t receive a full dose since the drugs first started being used for cancer treatment, which was as early as 2008. Fewer than 10 of the 1,000 patients required additional treatment as a result of the initial dosage being too small.
“Our first priority when this occurred was to make sure that the patients, where this may have occurred, were notified and if they required more treatment, that we would do,” said Dr. Robin McLeod, vice-president of clinical programs and quality initiatives at the Ontario agency.
Ontario hospitals have taken steps to correct the issue by examining the way the cancer drugs are administered, looking at their IV tubing and flushing methods and the pumps and filters they use in the process. An analysis of the contributing factors is underway, McLeod said.
In Manitoba, Czaykowski said CancerCare is expecting new tubing to be delivered Monday, and that should address concerns about underdosing. He said he doesn’t expect the 175 patients will be offered additional dosing.
maggie.macintosh@freepress.mb.ca Twitter: @macintoshmaggie
Maggie Macintosh
Reporter
Maggie Macintosh reports on education for the Winnipeg Free Press. Funding for the Free Press education reporter comes from the Government of Canada through the Local Journalism Initiative.
History
Updated on Saturday, August 18, 2018 12:12 PM CDT: Name fixed.