From the 'Lectric Law Library's Stacks
Medical Malpractice, Cancer, and the Medical Oncologist
The medical oncologist is a physician who has received specific training in the broad area of cancer management. This training includes an internship and residency in internal medicine followed by several years in post-doctoral training in the area of oncology. This is frequently combined with training in hematology that requires three years of post-doctoral work.
Cancer is increasingly a multidisciplinary discipline requiring input from a multiplicity of specialties and it is the responsibility of the medical oncologist to integrate the numerous physicians involved and oversee the complete treatment program. The medical oncologist does not specifically perform surgery or radiation therapy but should have training in their relative contributions to the overall treatment of cancer patients.
In evaluating whether a specific case of cancer diagnosis and treatment is consistent with the accepted standard of care there are several general principles to be considered. Was the physician aware of established signs of cancer and was sufficient attention paid to those signs? An example would be an abnormal lump in the breast or unexplained bleeding from a body orifice. While the role of the evaluation of these signs may be important, it is not, in and of itself sufficient reason to indicate that there is a genuine problem with the care.
A major consideration is whether or not the cancer itself is treatable. Would treatment alter the natural course of the disease? There may be significant errors in the diagnosis of the cancer. However, for certain types of cancers there are few good therapies available. A central issue is whether or not a delay in the diagnosis of cancer would alter the treatment approach. There are certain malignancies that when diagnosed later in the course of that cancer require more aggressive treatment. For example colon cancer diagnosed early would utilize surgery. If diagnosis is made at a later stage in addition to surgery lengthly chemotherapy would need to be included with the treatment plan.
Another critical aspect in many cases is whether the delay in diagnosis is accompanied by documentable change in the status of the cancer. Paramount is the important role of tumor size as an independent prognostic factor for curability and eventual outcome. An example would be a breast lump which is documented either on physical examination or radiographs to be a certain size, appropriate management is not initiated and later studies show substantive increase in size. It is known that this type of delay is accompanied by a subsequent decrease in curability. The patient who presents with bleeding from the rectum which was not evaluated until a second episode six to twelve months later may or may not be in a situation where a medical oncologist can make a definitive statement regarding decrease in overall survivability. Since it is not possible to identify the stage of the tumor at the time of the patient's original symptoms it would not be possible to make definitive statements regarding tumor progression during the period of the delay.
There are a small number of cancers which are potentially curable, even when presenting with disseminated disease such as testicular cancer, Hodgkin's disease and in some of the non-Hodgkin's lymphomas. The liability in these cases is substantially greater. Some cancers unfortunately simply have poor outcomes in the vast majority of circumstances. Lung cancer being a prime example. Mistakes in diagnosis and management may not have major clinical implications in terms of ultimate outcome.
Evaluation of patients with malignancy is complex and must be reviewed on an individual basis. The medical oncologist is frequently the ideal specialist to evaluate this type of case. Within the next four to five years it is predicted that cancer will be the number one cause of death in the United States and will be the primary reason for admission to the hospital. Legal professionals can expect an increase in potential cases related to the care of these patients.
* This article is presented and copyrighted by The 'Lectric Law Library
and Dr. Steven E. Lerner & Associates (www.drlerner.com)