World class Radiologist confirms gross departure from standard of care in failing to properly interpret chest x-ray dated 9/12/18, which showed "new rounded density 6 cm"). Delay of 10.5. months until 7/30/19 when CT confirms 7.7 cm mass. PETCT 8/5/19 reports 7.8 x 6.5 cm mass with SUV 19.7. Hospital note 10/11/19: Biopsy proven LLL NSCLC; thorocentesis neg. for malignant cells; most recent CT shows concern for progression of disease including concern for pleural nodules. Stage-Cancer 1; Stage - Clinical; Lung Cancer; T4 N 0. 12/4/19: Stage 4 lung cancer with mets to pleura. 2/17/20: dies.
Issue: Was the 10.5 month delay in diagnosis, considering there was no mets even when finally diagnosed, a cause of injury to decedent or did it diminish his chance of a better outcome?
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Do you believe there might have been medical error?
Large lesion on chest x-ray, not found until 10 1/2 months later. This lesion was proven to be a cancer, hence it had time to grow for 10 1/2 months before addressing it. Clearly, there is a relationship between size and risk of metastasis, and delay would’ve increased the chance for metastatic spread.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Lung cancer, when smaller, has increased, survival with proper treatment. A delay in diagnosis, with increasing size, makes it much more likely metastatic spread can occur, which decreases chance for survival Also, more growth means more cells, which increases chance of resistance to therapy. Either way, delay, reduces chance for cure, and likely increases need for more aggressive therapy.
What makes you a good expert for this case?
I am a medical oncologist, practicing for over 25 years. I see many lung cancer, patients, and make therapeutic decisions based on staging. I take part in weekly tumor boards, where we review, along with surgical Thoracic oncologists, radiologists, pathologists and radiation oncologists, providing best multidisciplinary approaches for many tumor types, often thoracic oncology cases.
How often do you encounter cases similar to this one in your practice?
I see new oncology patients virtually daily, about 15% of which have lung cancer. I have many patients in my practice that present with lung masses, where I am responsible for the work up and treatment decisions for these patients.
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