Early diagnosis and colorectal claims

Bowel cancer is the fourth most common cancer in the UK. Over 34,000 new cases of colorectal cancer are diagnosed in the UK each year. Although its prevalence has been linked to age (over 45), poor diet (high in fat, low in fibre), family history (of Familial Adenomatous Polyposis or Hereditary Non-Polyposis Colon Cancer) or a history of severe ulcerative colitis or Crohn’s disease, very little is known about its causes.

A delay in referring a patient with suspected colorectal cancer could shorten that patient’s life. Between January 2010 and March 2015, the MDU opened 453 files where a complaint or claim arose from an alleged delay or wrong diagnosis of colon/bowel cancer.

Colorectal cancer in primary care – when to refer?

The most common symptom of colorectal cancer is a change in bowel habits. These include:

• increasing constipation
• alternating bouts of constipation and diarrhoea
• blood or mucus in the stools
• a sensation of incomplete emptying of the bowels

NICE guidelines published in 2015 for Suspected cancer: recognition and referral, recommends referring adults for an appointment within 2 weeks, using the suspected cancer pathway referral, if:

• they are aged 40+ with unexplained weight loss and
• abdominal pain or
• they are aged 50+ with unexplained rectal bleeding or
• they are aged 60+ with:
  • iron‑deficiency anaemia or
  • changes in their bowel habit, or
• tests show occult blood in their faeces.

A referral under the 2-week wait rule should also be considered:

• in adults with a rectal or abdominal mass; and
• in adults under 50 with rectal bleeding and any of the following unexplained symptoms or findings:
  • abdominal pain
  • change in bowel habit
  • weight loss
  • iron‑deficiency anaemia.

Claims arising from delayed diagnosis

Where a claim for compensation is made following a delay in the diagnosis and treatment of cancer which resulted in the early death of a patient, there is usually a claim for the following types of damages:

• a statutory bereavement award;
• funeral expenses;
• pain and suffering that the deceased would have avoided with earlier treatment;
• any loss of earnings the deceased may have incurred as a result of the delay;
• loss of financial dependency that the family would have benefitted from if the deceased had lived longer and continued earning;
• loss of services dependency in respect of services that the deceased would have provided around the home had he /she lived longer.

For such a claim to succeed, the claimant must establish both of the following:

• Breach of duty – there was a delay which no responsible body of opinion would consider reasonable;
• Causation – on the balance of probabilities, the delay was causative of a quantifiable difference to the patient’s life, e.g. death, a shortened life expectancy, and/or pain and suffering endured during the delay. Alternatively, where there were multiple indivisible causes (negligent and non-negligent), the delay materially contributed to a quantifiable difference to the patient.

Conclusion

Early diagnosis of bowel cancer increases a patient’s chances of survival. If diagnosed late, it is harder to treat and places a higher financial burden on the NHS. Documenting a careful history (including duration of symptoms), any negative findings and confirmation that the patient has been advised to return if symptoms do not improve (safety netting advice) could prove invaluable in defending a claim for negligence.