CancerCare to contact patients

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This article was published 19/08/2018 (2767 days ago), so information in it may no longer be current.

CancerCare Manitoba said Sunday it will contact the estimated 175 patients who may have received a lower dosage of highly concentrated intravenous medication than they were prescribed because of the way the drugs were administered.

After media reported last week CancerCare Manitoba decided not to inform patients because notifying and alarming them might cause more harm than good, its chief medical officer said Sunday they will be getting in touch with the patients identified in the underdosing.

“It could be very upsetting to patients,” Dr. Piotr Czaykowski, CancerCare Manitoba’s chief medical officer, said Sunday. 

Some of the 175 Manitobans may have received as much as 15 per cent less than their prescribed dosage for one of three cancer drugs introduced in this province in the last two years. The good such a small amount might do to help patients was deemed to be much less than the harm a large amount of anxiety and stress in receiving that news would have on them, Czaykowski said.

Now, thanks to that news getting out, the affected patients have both the knowledge they received a lesser dose of the cancer-fighting drug, plus the anxiety and stress of knowing about it.

The underdosing was first reported by an Ontario nurse, who alerted Cancer Care Ontario in June about the inconsistent way cancer treatment drugs Pembrolizumab, Nivolumab and Panitumumab were being administered. Small amounts were left behind in IV tubes after treatments. The drugs are often used to treat patients in the late stages of cancer, such as advanced colon or kidney cancer or melanoma. Cancer Care Ontario passed that information along to hospitals in Ontario and their counterparts across the country, as well as Health Canada.

In Manitoba, CancerCare’s clinical team said Friday they decided not to notify patients. That decision was criticized by patients rights and medical ethics advocates. On Sunday, CancerCare was on the defensive, explaining its decision and reversing it. 

“There was no desire to hide or obfuscate anything,” Czaykowski said Sunday.  They were trying to do something for the patients’ own good, said the doctor. That decision not to inform patients has been criticized as “paternalistic” but that was never their intent, he said.

“We take that criticism square on the chin,” Czaykowski said. “It wasn’t our thinking that we know better than everyone else. We legitimately thought this was something that would cause anxiety and distress among the patients,” he said. 

“The way these drugs are administered, they’re not finely calibrated.” Czaykowski said there’s a plus or minus 10 per cent dosing variance for administering them. Getting 10 per cent more or less “realistically” has no chance of producing an adverse outcome, he said.

Still, they’ll get in touch with patients who were potentially underdosed to tell them, he said Sunday. 

“We’ll be notifying them directly by phone wherever possible,” and by other means if necessary “to make sure they all know about it,” Czaykowski said. 

“We’ve been discussing the best way to get a message to our patients,” he said. Information will be posted on the CancerCare Manitoba website.

For CancerCare Manitoba, this has been a learning experience, Czaykowski said.

“It’s a fortunate thing these situations don’t arise very often. When they do arise, you have to learn from them,” he said. “Every time something like this happens, we double down and look at what processes are in place… That’s what’s happening right now. We’re analyzing the whole process,” he said.

CancerCare is looking at all of its processes for administering intravenous chemotherapy drugs “to make sure we don’t have any other surprises.”

carol.sanders@freepress.mb.ca