Missed or delayed cancer diagnoses comprise nearly 38% of malpractice claims involving serious harm, a recent study found, adding to a growing body of evidence that such misdiagnoses are far from outliers.1

The analysis, based on a decade of 55,377 closed malpractice claims, found that cancer misdiagnoses led the 3 largest clinical categories where serious patient harm resulted, followed by vascular events (22.8%) and infections (13.5%). (Serious harm included death, paralysis, or other major disabilities, such as brain damage.) Among malignancies, lung cancer cases were most frequently misdiagnosed, followed by breast and colorectal cancers, according to the analysis, which was published in the journal Diagnosis.1

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“Lung cancer is probably at the top of the list both because it’s a disease that we tend to miss because its symptoms are nonspecific, and there is less effective implementation of [lung] screening guidelines,” said David Newman-Toker, MD, PhD, the study’s lead author and the director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence, Baltimore, Maryland. Also, he added, that it’s likely subjected to more malpractice scrutiny “because at some level whatever delays do happen have a much bigger impact on patient health.”

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Most of these errors happen in an outpatient setting before patients ever reach a specialist, Dr Newman-Toker noted. But oncologists and other cancer physicians can still play a significant role in reducing misdiagnoses, he said — especially as it relates to care delays. For instance, they can speak with referring physicians if they notice a pattern, such as too many patients with colorectal cancer being referred after many months of fatigue and iron deficiency anemia.

To guard against delayed lung cancer diagnoses, cancer physicians can remind their busy primary care colleagues that there should be follow-up for every nodule, even if it was caught as part of an unrelated imaging test or if the patient has never smoked, said Brendon Stiles, MD, a thoracic surgeon at NewYork-Presbyterian/Weill Cornell Medical Center in New York City. 

Dr Stiles was one of the authors of a retrospective review published online in 2017, which showed that never-smokers comprised 16.1% of lung cancer patients who underwent resection for non-small cell lung cancer (NSCLC) at that institution more than a decade ago (1997-2007) compared with 29.1% who underwent the same  procedure from January 2013 until June 2016.2

It’s frustrating to meet with a patient who could have been treated sooner, Dr Stiles said. “I’ll often see patients in my practice who were treated for pneumonia for months before they got moved on for appropriate imaging and diagnosis,” he said.