A woman whose health treatment became part of a national patient safety investigation because doctors missed an opportunity to diagnose her lung cancer months earlier says she hopes lessons will be learned and changes made.
Tracey Ketch, of Sutton Coldfield, believes her symptoms of a persistent cough and feeling short of breath were ‘dismissed’ by health professionals because she was an otherwise healthy 50-year-old who was a non-smoker at the time.
She was first seen by a nurse practitioner at her GP surgery after symptoms had persisted for a few months, when she was diagnosed with a chest infection and given antibiotics.
As her symptoms did not go away, she saw the nurse practitioner a further three times over and was prescribed three further courses of antibiotics.
She was finally referred to the Good Hope Hospital in Birmingham for a chest x-ray on May 10, 2019, which was carried out the same, day.
Due to some uncertainty about the results, a second x-ray was also carried out and reviewed, with radiologists concluding there were no serious findings, and she was told ‘everything was clear.’
However, symptoms persisted and she returned to her GP in January 2020, having also started to suffer chest pains. Her GP requested an urgent chest CT scan and also sent her to the emergency department where tests ruled out possible heart problems. Another x-ray was performed with no concerns identified.
Finally, the CT scan was performed on 2 February 2020, where a 4cm tumour was found with secondary growths throughout the lungs.
When Mrs Ketch saw a consultant to discuss her diagnosis, she was told that the previous X-rays had indeed suggested that cancer may have been present, but had been missed.
It was the consultant who then reported the incident, leading to a review by the Healthcare Safety Investigation Branch (HSIB). That found that around one in five lung cancers are missed on x-rays, which is increasing in non-smokers.
It also concluded that ‘media messaging highlighting the close link between lung cancer and smoking, and the often non-specific symptoms of lung cancer, have created a significant diagnostic challenge for GPs.”
‘I couldn’t understand how it had been missed on x-rays’
Recalling her diagnosis, Mrs Ketch says she was “shocked and tearful”, and “confused and worried”.
“I didn’t accept it at first,” she said. “I’d had had three X-rays and been to A&E, so I thought how could I go from being all clear to having cancer all over my lungs?
“Because I’d been to my GP so many times, and told it was a chest infection, I was telling myself it was all in my mind and that it was stress. At the time I was having all these symptoms my husband had suffered a stroke, so I convinced myself it was to do with the strain of life, as I was having to care for him also.”
As a result of legal action, launched by Hudgell Solicitors, University Hospitals Birmingham NHS Foundation Trust admitted reviews of chest x-rays in May 2019 and June 2019 fell below expected standards, in that the tumour, which had been visible, was not identified.
It also admitted that, had the radiographs had been appropriately interpreted, investigations would have led to an earlier diagnosis of the cancer.
Mrs Ketch has thankfully responded well to treatments, in the form of daily tablets, with her latest three-monthly scan showing her to be stable, “which means the cancer isn’t growing, which is of course positive, but I don’t like to ask about things too far ahead,” she says.
“I know there will be a time when the tablets stop having a positive impact and I may have to look at chemotherapy and radiotherapy, but I choose to live in the here and now and not worry. It is how I cope. I’ve also wanted to make sure lessons are learned.”
That desire to see change made influenced her decision to play a full part in the HSIB investigation, which concluded in October 2021 and recommended research into greater use of CT scanning.
“I think my case highlights just how easy it is to slip through the net if you have lung cancer but are otherwise health and a non-smoker,” she said. “I’m sure my cancer was missed because I am a non-smoker. I feel my symptoms were dismissed as soon as the question of smoking was covered.
“It’s a tick box system but no two people are the same. It was the consultant who reviewed my previous x-rays and said that I should take legal advice. He wanted to ensure lessons are learned.”
Solicitor Shauna Page, of Hudgell Solicitors, led the legal case on behalf Mrs Ketch, agreeing an out of court damages settlement with the Trust in September 2022.
She said: “Tracy has been incredibly brave in how she has handled what happened to her and how she has been fully involved in investigations to help learn and improve healthcare in the future.
“The failing in Tracey’s case was the interpretation of the x-rays, which actually had picked up the tumour and should have been spotted. That led to a six-month delay in diagnosis, which of course, in cases relating to cancer, can potentially have a damaging impact on the success of future care and treatment.
“In this case, thankfully, the opinion of experts consulted was that the delay will not have negatively impacted on the treatment. However, the delay should not have happened, and it was only right that the consultant who spotted this highlighted it and ensured it was taken further and investigated fully.”
Report calls for research into ‘low dose CT scanning’
The Healthcare Safety Investigation Branch investigation into Mrs Ketch’s case was completed in October 2021.
It highlighted the importance for healthcare professionals to be provided extra guidance to ‘make clearer what should be offered to patients who have ongoing, unexplained symptoms after a negative chest X-ray’.
It also said that, as CT scanning is a more accurate test to diagnose lung cancer and is used more widely in other developed countries which have better cancer survival rates, research should be conducted into the clinical and cost-effectiveness of using low-dose CT scanning (which exposes a patient to a smaller amount of radiation compared to conventional CT),
Just last month, the UK National Screening Committee (UKNSC) also recommended that anyone aged 55 to 74 who smokes or has done in the past should be offered a low dose CT scan. The proposal is being supported by Cancer Research UK.
In a pilot scheme, the number of stage one and two lung cancer cases identified was quadrupled when a mobile CT scanner was placed in shopping centre car parks.
Making a medical negligence claim
No matter how high the standards of care and treatment in our health services, things can sometimes go wrong.
Medical negligence occurs if you receive substandard treatment by a medical professional, whether that’s directly causing an injury, or making an injury or condition worse.
Medical negligence can also happen if you are misdiagnosed, receive the wrong treatment, or a mistake is made during surgery.
