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December 2011
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Chemotherapy: Putting Patient Safety First
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Comment from Alison Jones, Chair of the Associate of Cancer Physicians
The NCEPOD report should be welcomed by the oncology community as presenting an opportunity to develop audit tools and adopt an open approach to monitoring the appropriateness and safety of SACT at local, network and national level. It should lead to the development of practice guidelines and recommendations to improve the patient experience.
The incidence of neutropenic sepsis leading to death is of particular concern, and raises important questions about: dosing of chemotherapy and decision-making processes in very sick patients, the use of primary and secondary prophylaxis of neutropenia in-line with recognised international guidelines, and the need for agreed pathways of care, both within units delivering SACT and across unit boundaries.
Elsewhere, the report highlights the need for ongoing and iterative discussion of the risks and benefits of chemotherapy for individual patients in terms that the patient can understand. It also stresses the importance of introducing supportive or palliative care services early in the course of metastatic disease as part of a holistic package of care, rather than as “opt out” when SACT is deemed no longer appropriate. Within oncology, a culture of audit should be encouraged, with attention to audits of mortality, neutropenia and patterns of care. The profession itself is aware of the need for communication, and there are opportunities to build this into both appraisal and revalidation.
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