Mid and South Essex NHS Foundation Trust

3. Mrs A complains about cancer care and treatment Mid and South Essex NHS Foundation Trust provided to her late father, Mr B, during March and April 2024. Specifically, that the Trust:

• gave her father tablet chemotherapy instead of intravenous chemotherapy.

• failed to provide advice when her father’s health deteriorated, including his increased risk of sepsis, and that he should attend A&E if he was vomiting for a long period.

4. Mrs A told us the above events caused her father significant distress, and he sadly died on 28 April 2024. Mrs A feels that if the Trust had carried out IV chemotherapy, her father may not have died when he did. Mrs A says the Trust’s failure to provide advice when her father’s health deteriorated, caused Mr B to feel scared and delayed his attendance at A&E for urgent treatment. Mrs A told us that she, and her family, experienced a significant distress and extreme guilt from seeing their father suffer unnecessarily.

5. As an outcome Mrs A would like service improvements and financial compensation.

6. Mr B had metastatic melanoma (a skin cancer that had spread to other areas of his body). In March 2024, the Trust prescribed oral chemotherapy. Six weeks later he was admitted to hospital with vomiting secondary to chemotherapy, and he was also diagnosed with an acute kidney injury, lower tract respiratory infection and sepsis. Sadly, his condition deteriorated despite medical management, and he died seven days later. We offer Mrs A and her family our condolences for their loss.

Oral chemotherapy treatment

10. We have considered the Trust decision to prescribe oral chemotherapy. NICE clinical guideline NG14 ‘Melanoma: assessment and management’ says,

‘For people with previously treated melanoma in whom immunotherapies and targeted therapies are contraindicated, unsuitable or unacceptable, consider:

• treatment with chemotherapy (dacarbazine) or • best supportive care’.

11. Mr B’s family asked the Trust to change his chemotherapy three times between 21 and 25 April 2024. We discussed with our adviser if there was any indication the Trust should have provided IV chemotherapy to Mr A. Dacarbazine is an IV chemotherapy. Our adviser explained the Trust should not have provided IV chemotherapy. Mr B had sepsis and renal failure, both of these are contraindications for IV chemotherapy.

12. The records show that the Trust prescribed chemotherapy drug temozolomide. This is an oral chemotherapy in the same class as of medicine as dacarbazine. While this is not the type of chemotherapy specified by NICE (see above) our adviser explained it is a suitable alternative when IV chemotherapy is contraindicated. Our adviser said it is not an unreasonable prescription. Dacarbazine (as recommended by NICE) can have some significant and unpleasant side effects, whereas temozolomide is very well tolerated. Whilst NICE guidelines recommend dacarbazine therapy, Mr B did not lose the opportunity for a better outcome as his prognosis was very poor before chemotherapy began.

13. In summary, whilst we understand the family feel Mr B was provided with the incorrect treatment, we consider the Trust provided the best option considering Mr B’s other health issues at the time. We hope our explanation provides reassurance that Mr B was treated in line with relevant standards.

Advice upon deterioration

14. GMC ‘good medical practice’ guidance says,

‘38 You must support patients in caring for themselves and empower them to improve and maintain their health. This may include:

• helping them to access information and support to manage their health successfully • supporting them to make decisions that improve their health and wellbeing.’

15. Mrs A says the family attempted to contact Mr B’s consultant for advice when he became unwell but were not responded to for over ten days. In response, the Trust says Mr B was advised to contact the chemotherapy 24-hour triage helpline with any concerns or questions, but they have no record of any calls to the helpline.

16. The Trust did advise Mr B to contact the chemotherapy 24-hour triage helpline with any concerns or questions about his treatment. That should have been his first point of contact rather than his consultant. Access to an NHS service should not be through one individual who may be uncontactable for one of many reasons. It is not unreasonable that the oncologist did not respond to emails from the family given the Trust has an established helpline for such advice. We do not even know when the consultant might have seen these emails.

17. Whilst we understand the family were concerned for Mr B’s comfort in his final weeks, it did have the contact details for the Trust’s chemotherapy hotline which is managed 24 hours a day. The Trust could have arranged for timely intervention and advice via that helpline. We have seen no indication the Trust failed to provide access to information and support as per GMG guidance.

18. We understand that this does not take away the distress from what was a challenging and upsetting time for the family. It must have been very difficult for them when Mr B became more unwell.

1. We have carefully considered Mrs A’s complaint about Mid and South Essex NHS Foundation Trust (the Trust). We have seen no indication that anything went wrong.

The Trust prescribed appropriate chemotherapy for Mr B and provided the family with a 24-hour helpline to contact should Mr B suffer any side effects.

2. We understand what happened was to Mr B towards the end of his life was distressing for him and his family. We hope our explanation provides reassurance that Mr B was treated in line with national guidance.