Breast Cancer Treatment Mistakes to Avoid

Torpey Bashaw

Findings from a new study can provide insight to healthcare executives and risk managers regarding how to complete a proactive risk assessment in breast cancer treatment and diagnosis.

With the exception of skin cancer, breast cancer remains the most common cancer among American women. It affects approximately one in eight women and is the leading cause of cancer-related death. Additionally, a small number of men are diagnosed with and die from breast cancer yearly. The good news is that the overall rate of newly diagnosed cases began to decrease in 2000, and the overall death rate has continued to trend downward over the past 20 years.

To identify breast cancer risks and provide insights into potential vulnerabilities for providers and patients, medical malpractice providers CRICO Strategies and The Doctors Company recently partnered on a detailed analysis of 562 breast cancer medical malpractice claims from 2009 to 2014.

“We decided to collaborate on a more comprehensive study because we understood the frequency with which these cases occur and the devastating impact that these patients suffer,” says Kerin Torpey Bashaw, MPH, BSN, RN, senior vice president of patient safety and risk management. “We hoped to identify key issues that would help primary care providers correctly and timely diagnose their patients who have breast cancer and help treating physicians manage these cases.”

Key risks

The study, based on a detailed analysis of 562 breast cancer medical malpractice claims, found:

• As expected, failure to accurately and timely diagnose breast cancer was the most common allegation (88%). This allegation is closely related to the top factor that contributed to patient injury, inadequate assessments (71%), which are essential for arriving at the correct diagnosis. Assessment issues included misinterpretation of diagnostic studies, inadequate history and physical, and failure or delay in ordering diagnostic tests. “More specifically, in some cases, there were failures to update patients’ family history,” Torpey Bashaw says.

• A significant number of claims and suits included a contributing factor of patients failing to attend follow-up appointments (9%) or not adhering to treatment plans (6%). “We suspect that some of these cases are associated with inadequate communication between patients and their physicians (16%). Some patients claimed that they did not understand the purpose or urgency of the test or appointment,” she says. “Communication goes both ways and some of these cases resulted from inadequate information being provided by patients, which is necessary for physicians to make correct diagnoses and order the appropriate diagnostic tests.”

• The second most common factor that contributed to patient harm was inadequate communication between providers (12%).

Findings from this study can provide insight to healthcare executives and risk managers with regards to focus areas to complete a proactive risk assessment. “A proactive risk assessment looks at specific areas that are risk prone prior to any known incidents so that the potential for a bad outcome can be mitigated, reduced, or eliminated before it might happen,” she says. 

In the study, inaccurate and untimely diagnosis were often associated with inadequate assessments, communication between patient, family, and provider, communication among providers, patient noncompliance with follow-up appointments and breast treatment plans, and failure or delay by the physician in obtaining a consult, according to Torpey Bashaw.

Management and treatment claims were associated with improper performance of surgery and management after surgery. Communication issues between patient/family and providers also contributed.

“Areas associated with claims in the study are areas that healthcare executives may want to assess proactively in their risk management programs,” she says. “Organizations should evaluate their policies and processes to determine if they can identify system weaknesses that have the potential to harm patients.”

Other unique findings include:

• A significant number of breast cancer claims were related to care provided after patients were diagnosed. Patients sometimes experience harm from surgery or other forms of treatment.

• Diagnosis is related to more than the initial diagnosis of breast cancer. Diagnosis also is a factor for patients following surgery or other treatment when they experienced complications of the procedure or reactions to medications.

Based on the study, Torpey Bashaw offers six takeaways:

• In most cases, harm is preventable.

• Frequently, patient harm was due to system failures.

• Medical malpractice claims review can provide direction for leaders to focus improvement efforts to reduce or eliminate the chance of harm before it happens.

• For breast cancer diagnosis, a comprehensive assessment including family history of breast cancer, timely ordering and proper interpretation of diagnostic studies, communication of test results, and the effectiveness of hand-off communication are key areas to assess.

• For breast cancer treatment and management, claims were associated with improper performance of surgery, improper management of patients after surgery, and communication issues between patient/family and providers.