Lung & mediastinum
Delayed and missed diagnosis of lung cancer
Delay claims in lung cancer stand or fall on a single question: what could have been done at the missed opportunity that could no longer be done when the diagnosis was actually made. That is a surgical question, and it is the one I am instructed to answer.
How these claims arise
Where the opportunity gets missed
What I am asked to determine
Five questions, in sequence
Working from the imaging available at the time, what the likely stage was when the opportunity to diagnose was missed. This is the foundation of the whole claim and it usually requires the images themselves, not the reports.
Whether the tumour was surgically resectable at that stage, what operation would have been offered — lobectomy, segmentectomy, sleeve resection, pneumonectomy — and by what approach.
Whether the patient’s lung function, cardiac status and performance status at that time would have permitted the operation. A tumour that was anatomically resectable in a patient who was not fit for resection does not advance the claim, and this is a point that is often assumed rather than examined.
Whether the tumour had progressed to a stage at which surgery was no longer offered, whether nodal or distant disease had appeared, and whether the operation that could be offered had become more extensive or more morbid.
Effect on treatment options, on the extent of resection, on the need for adjuvant therapy, and on prognosis. Where the question is one of statistical survival I will normally say so and recommend that the survival evidence comes from an oncologist; my evidence is on what surgery was and was not available and what it would have achieved.
Points that decide these cases
What the analysis usually turns on
The interval is not the injury
A delay of nine months in a tumour that was already unresectable at the first opportunity produces no recoverable loss. A delay of six weeks that takes a patient from a segmentectomy to a pneumonectomy produces a substantial one. The length of the delay matters far less than what it crossed.
Nodal status is usually the pivot
Progression from N0 to N2 disease frequently changes the treatment paradigm entirely. Establishing nodal status at the earlier point, from the imaging available, is often the single most important piece of analysis in the report.
Screening claims are increasing
With targeted lung health checks now operating across much of England, a distinct category of claim is emerging around nodules identified on screening and then inadequately followed up.
Scope of instruction
What I will need and where the boundary sits
What I will need
Records- All imaging as images, with the original reports
- The full GP record
- Secondary care records including MDT documentation
- Pathology from any biopsy or resection
- Lung function tests
- Records of the treatment actually given
Where the boundary sits
Outside my expertiseWhether a lesion was visible and should have been reported is a question for a thoracic radiologist.
Whether a GP should have referred is a question for a general practice expert.
Survival statistics and the effect of delay on systemic treatment are questions for an oncologist.
Most delay claims need two or three experts, and instructing them in the wrong order wastes money.
I will tell you the order on the merits call.
Discuss a case
Fifteen minutes on the telephone, free of charge. I will tell you whether the issues fall within my expertise before anything is committed to paper.
Discuss a case