Ashford and St Peter's Hospitals NHS Foundation Trust

3. Mrs O complains Ashford and St Peter's Hospitals NHS Foundation Trust (the Trust) diagnosed her sister, Ms C with stage four lung cancer too late. She states the Trust focused on infection in the lung, not recognising that there was also cancer present. She also states the Trust should have carried out a PET (positron emission tomography) scan sooner.

4. Mrs O states as a result of this her sister has been left with a terminal condition which could have been prevented, she has had to leave her job and the whole family has been impacted.

5. By bringing her complaint to us, Mrs O is looking for £12,500+ financial remedy as her sister’s life has been shortened.

Background:

6. On 27 February Ms C presented at the Trust with chest pain, the Trust carried out an ECG (A chest ECG (electrocardiogram) is a quick, painless test that records the heart's electrical activity to help diagnose various heart conditions).

7. On 28 February Ms C attended same day emergency care (SDEC) at the Trust with sharp, right sided pain. The Trust carried out an ECG and an X-ray, it informed her it was muscular, reassured her, and advised her to stop smoking.

8. On 3 March, emergency call paramedics attended to Ms C at home as she had blood in her phlegm and right-handed chest pain. She attended hospital, and was diagnosed with community acquired pneumonia (CAP, a type of lung infection that occurs in individuals outside of a hospital or healthcare setting, often caused by bacteria, viruses, or fungi). The Trust ruled out blood clots, and prescribed antibiotics. A follow up CT scan (computed tomography scan, is a non-invasive imaging test that uses X rays and computer technology to create detailed images of the inside of your body) was arranged for six weeks' time.

9. On 3 March, 19 March and 21 March the Trust carried out a CT scan.

10. On 21 March, Ms C attended a review appointment at the Trust with Mrs O. Mrs O states the consultation did not take place in a private room, and was behind a curtain on a ward, she says the CT image could not be found. The consultant informed them there had been no change, there was no mention of possible cancer. The plan was for the Trust to review Ms C in three weeks’ time, and repeat a chest x-ray and blood tests.

11. On 13 April and 19 April the Trust carried out a chest x-ray.

12. On 22 April, Ms C attended same day emergency care (SDEC) at the Trust with a persistent cough, chest pain going into her back and blood in her sputum despite receiving three courses of antibiotics. A chest X-ray was taken. A CT scan with contrast (a diagnostic imaging procedure that uses a special dye (contrast agent) to improve the clarity of images produced by the scan) was arranged for 5 June.

13. On 22 April, the Trust made a lung cancer MDT referral (multi-disciplinary team referral involves a group of healthcare professionals from various specialties who collaborate to discuss and plan the care of individual patients) for Ms C.

14. On 26 April a nurse at the Trust contacted Ms C following an MDT meeting and informed her there had been improvement in her condition, but they would continue to monitor her.

15. On 5 June the Trust carried out a high-resolution CT chest scan (specialized imaging technique that provides detailed cross-sectional images of the lungs. It is primarily used to diagnose and monitor lung diseases, offering better image resolution than standard CT scans)

16. On 6 June the Trust carried out a flexible cystoscopy (minimally invasive procedure that allows doctors to examine the bladder's interior using a thin, flexible tube called a cystoscope.)

17. On 10 June Ms C attended the acute walk in centre due to experiencing right sided chest pain and shortness of breath. An X-ray and blood tests were taken.

18. On 13 June Ms C attended the Trust for a review scan. A doctor informed her they were more concerned about TB (Tuberculosis (TB) is an infection that usually affects the lungs) rather than cancer and arranged for a bronchoscopy (a test which can help to diagnose and treat conditions of your breathing. It involves a doctor sliding a flexible camera-tube into your lungs) to be performed.

19. On 20 June the Trust carried out a bronchoscopy, which reported a tumour, and a biopsy was taken. A PET scan was organised.

20. On 27 June, a PET scan showed Ms C sadly had stage 4 lung cancer. On 28 June the Trust informed Ms C of her diagnosis.

24. Mrs O complains the Trust diagnosed her sister, Ms C, with stage four lung cancer too late. She states the Trust focused on infection in the lung, not recognising that there was also cancer present. She also states the Trust should have carried out a PET scan (positron emission tomography, an imaging test that helps diagnose conditions by showing how your tissues and organs are functioning, particularly in detecting cancer, heart disease, and brain disorders) sooner.

25. In its response, the Trust state the PET scan is used to find out what stage the cancer is at and does not diagnose cancer.

26. Ms C was diagnosed with a community acquired pneumonia and received CT imaging twice, on 3 March and on 21 March. The results of both scans supported the diagnosis of CAP rather than cancer. Our adviser explained the CAP diagnosis could have explained Ms C’s symptom of coughing up blood.

27. NICE guidance on suspected lung cancer state:

• ‘Refer people using a suspected cancer pathway referral for lung cancer if they: • have chest X-ray findings that suggest lung cancer or • are aged 40 and over with unexplained haemoptysis’

28. Doctors at the Trust requested a third CT scan in June to ensure resolution of the pneumonia, which is when it needed further investigations, due to lack of resolution of the pneumonia. This is when the Trust first suspected cancer.

29. NICE guidance on lung cancer diagnosis and management states:

• ‘Ensure that all people with lung cancer who could potentially have treatment with curative intent are offered positron-emission tomography CT (PET-CT) before treatment’

30. The Trust carried out a bronchoscopy (a medical procedure that allows doctors to examine the inside of the lungs and airways using a thin tube) and PET-CT on Ms C in June 2024. Our adviser explained this was appropriate investigation and was carried out at an appropriate time. Cancer was not suspected in any of the CT scans prior to June 2024, therefore, in line with NICE guidelines a PET-CT scan was not relevant prior to this point.

31. In considering the above evidence, we consider the Trust acted in line with NICE guidance when carrying out tests to diagnose Ms C’s condition. It carried out relevant scans at the right times including a PET scan, and MDT (multidisciplinary team) reviewed the scans and made appropriate follow up plans. We do not consider the Trust could have diagnosed Ms C’s cancer any sooner than it did.

32. We appreciate this is an extremely difficult and sad time for Mrs O, Ms C and their family, we hope they can be reassured that we have taken their concerns seriously.

1. We have carefully considered Mrs O’s complaint regarding Ashford and St Peter's Hospitals NHS Foundation Trust (the Trust) delaying diagnosing her sister, Ms C with cancer. We are very sorry to hear about Ms C’s experience and how quickly her condition has deteriorated. We recognise how strongly Mrs O feels about this complaint.

2. We have seen no indication that anything went seriously wrong with the timescales the Trust carried out tests to diagnose Ms C with cancer.