MANCHESTER—Cancer expert Professor Karol Sikora has accused the General Medical Council (GMC) of selecting patients from an “envelope” in order to make its case against world-renowned oncologist Professor Justin Stebbing, a medical tribunal heard.
Defence witness Prof Sikora said Prof Stebbing’s record showed many of his patients had responded well to treatment and had gone on to live a “significant period of time”.
Prof Stebbing, a cancer medicine and oncology professor at Imperial College London with a private practice in Harley Street, is appearing before a Medical Practitioners Tribunal Service (MPTS) fitness to practise hearing accused of failing to provide good clinical care to 12 patients between March 2014 and March 2017.
The 36 charges – 21 of which he’s admitted – include allegations he provided inappropriate treatment to patients given their advanced cancer or poor prognosis, overstated life expectancy and the benefits of chemotherapy, and continued to treat patients when it was futile and they had just weeks to live.
Prof Justin Stebbing
12 Patients
MPTS panel Chair Hassan Khan questioned why Prof Sikora had mentioned “on a number of occasions” that the 12 patients had been “selected”.
“No oncologist has 12 patients like this,” replied Prof Sikora.
“Nobody has 12 patients like this over the last year.
“Clearly, what’s happened was a review was performed at Imperial, a review was performed at the London Clinic, a review was performed by AXA PPP and patients came to light.
“These patients have been put into this envelope here. How the GMC selected patients further I really don’t know.
“But I think we all have to agree these are selected examples from Prof Stebbing’s portfolio of patients.”
Mr Khan said a “sample of patients” was a more “neutral” term and Prof Sikora shouldn’t concern himself with how the GMC had selected patients.
End of Life
Prof Sikora also told Mr Khan that the patients could not be considered to be at “end of life” if they hadn’t received treatment.
“Some of the patients had never been treated before,” he said.
“You can’t consider them end of life until you’ve tried treatment.”
When Mr Khan asked whether that applied to all 12 patients, Prof Sikora replied: “I think they’re all at different stages.
“Each one has to be assessed depending on the type of cancer and the likely response rate to the intervention and the patient’s make up.”
Patient F
The tribunal discussed the case of one Stage 4 female lung cancer patient, Patient F, who had been admitted to hospital in a critically ill condition in March 2016 after undergoing a lung operation and immunotherapy.
She died the same month and Prof Stebbing is accused of making decisions based on an unrealistic prognosis, which included reversing a DNAR order, reversing a previously agreed ceiling of care, and providing assisted ventilation to the patient.
Sharon Beattie, QC for the GMC, said the “realistic” prognosis for the patient at that time would have been 2 or 3 months, to which Prof Sikora agreed.
Ms Beattie said Prof Stebbing had stated the patient’s prognosis was 18 months, even though her condition was deteriorating, and that had guided decision making leading to her being moved to ITU.
She said this was “wholly unrealistic” and the prognosis may have been 8 to 10 months at most.
Prof Sikora responded: “It would predicate a good response to immunotherapy but we don’t know because there wasn’t enough time to measure it.
“It wasn’t wholly unrealistic, it was looking at the best possible [outcome].
“There are patients like this who have lived significantly longer than 18 months.”
Ms Beattie said Patient F had wanted to “die at home” and there should have a been a realistic discussion about her prognosis and likely response to treatment, which also included chemotherapy prescribed by Prof Stebbing.
She said the reality was there was a “low probability” the chemotherapy would have any positive impact given the burden of her disease.
Prof Sikora replied that “it wasn’t a high probability” but the patient’s family had “wanted the best for her” and it was uncertain why her condition had deteriorated so quickly.
Patient G
Prof Stebbing is accused of inappropriately prescribing chemotherapy, and inappropriately escalating treatment, for another patient, a 73-year-old man who had lung cancer that had spread to his liver and abdomen.
The patient, known as Patient G, who also suffered pneumothorax and surgical emphysema, died in April 2016, and the tribunal previously heard how colleagues at the London Clinic had raised concerns about the chemotherapy.
Prof Stebbing was later suspended by the private hospital after “losing the confidence” of staff.
Ms Beattie said the patient had been “going downhill” and was someone who was “critically unwell” with a performance stage 4 by the time he was given the chemotherapy.
But Prof Sikora said the patient’s response to chemotherapy could have been “as high as 70%” but the problem had been the pneumothorax which had caused “sudden degeneration” in his condition which became “unusually bad”.
“Poorly differentiated lung cancer responds better and faster to well differentiated lung cancer,” he said.
“The real knock he had was the pneumothorax which set him back considerably and that was potentially reversible.”
‘Fruitless’ Chemo
Ms Beattie said the reality was the chemotherapy was “fruitless” and Prof Stebbing had had the opportunity to reassess the patient’s condition.
She reminded the tribunal how he’d clashed with one colleague – Nuala Close, former matron at the London Clinic – over the treatment when he told her: “The patient is f***** anyway so whether we give it or don’t he will die.”
This prompted Prof Sikora to laugh, leading to a rebuke from Mr Khan.
Ms Beattie said the comment showed that the patient’s prognosis was poor and giving him chemotherapy was “futile”, and a ceiling of care should have been established.
But Prof Sikora maintained the treatment was “appropriate” and it was the patient’s pneumothorax that caused his condition to deteriorate.
Patient G eventually did receive the chemotherapy at the hospital but died a few days later.
The tribunal continues.
Prof Sikora comments on cancer issues for Medscape UK.
Ian Leonard is a freelance journalist experienced in covering MPTS hearings.
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Lead Image: MPTS
Image 1: Kerry Elsworth