Delayed diagnosis is the most common cause of litigation in patients with cancer. The events that bring about malpractice suits generally involve miscommunication or lack of communication between patient and physician, alleged misreading of pathology slides, or alleged failure to do a follow-up regarding symptoms or presence of masses. Although a delayed diagnosis might seem to point to the actions of the primary care physician, who should be the first to observe signs and symptoms of malignancy, other practitioners are often involved: the pathologist who looks at the tissue sample for evidence of malignant changes, the radiologist who looks at the plain film or orders more advanced imaging modalities, and oncologists and members of the oncology team who will likely become just as deeply involved either as defendants in the litigation process either as a physician providing care or as expert witnesses.2,5

Specific to the oncology specialty are claims involving chemotherapy. Chemotherapeutic agents have a narrow therapeutic index compared to many of the drugs employed in other specialties. Even a small error in chemotherapy prescribing, mixing, and/or administration can be fatal. In addition, the oncologist and oncology pharmacist must be attentive to drug‑drug interactions with the multiple drugs used for supportive care (e.g., steroids, antiemetics, growth factors, prophylactic antibiotics). Because of the relatively narrow window for error with the drugs used to treat cancer, their use more easily triggers litigation. For example, “brown-bagging” by insurer‑designated specialty pharmacies results in a loss of control by the oncology team over the quality of the drug, and how cancer care is prepared and delivered. Nonetheless, when things go wrong, it is the oncologist, the oncology practice, and hospital staff that foots the blame.5

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In addition, the benefits of oral chemotherapy come at a price. Birner and colleagues have demonstrated that a shift from parenteral to oral chemotherapy may result in less than optimal patient compliance.6 Pearl Moore, co-founder of the Oncology Nursing Society, commented in 2006 that the shift to oral therapies and out of oncology services results in many missed opportunities for educating patients about the therapies, how to take the drugs, and their adverse effects.7

Privacy concerns relating to the Health Insurance Portability Act (HIPAA) are also a possible precursor to litigation. Informed consent issues become more complex in today’s environment. Often, according to Bronstein, the consent form is over 30 pages and is difficult to summarize in a concise and effective manner. Telling the patient who has been told that he or she has only eight months to live that this is a cancer drug that will allow survival beyond five years lends itself to future litigation. Good doctor-patient communication is always paramount, and informed consent is no exception.