An oncology expert witness advises on a case involving a 46-year-old female patient with a known medical history of early stage breast cancer. The cancer was surgically excised, and the patient had been monitored fairly closely since. She was found to have elevated tumor markers, significant abdominal pain, and documented weight loss. A CT scan of the lower abdomen revealed liver metastasis. A CT-guided liver biopsy confirmed she had spindle cell carcinoma of the breast. The patient was prescribed Lupron, and continued to complain of weight loss, nausea, fatigue and abdominal pain. She underwent an upper endoscopy and was informed that the findings were unremarkable. She was later evaluated and tumor markers were even higher than they had been previously. It is alleged that she was not informed of her elevated tumor markers during a follow up examination that year. The plaintiff claims there was a failure to timely administer appropriate treatment for cancer (i.e., performing surgery to remove the cancerous mass in this instance). The patient is terminally ill and undergoing chemotherapy using Taxotere at present.
Question(s) For Expert Witness
1. Given the presence of elevated tumor markers in a patient with this clinical profile, would a more thorough follow up have been warranted?
2. Do you routinely treat patients with a similar profile to the one described in this case?
3. Would earlier intervention have resulted in a better outcome for this patient?
4. Have you ever served as an expert witness on a case similar to the one described above?
Expert Witness Response E-008980
I am an expert in breast cancer and have seen numerous patients with a similar presentation in a clinical setting throughout the course of my career. I've also seen malpractice claims (as a reviewing expert) similar in nature to the case described. I am well aware of the proper procedures and protocol following the discovery of elevated tumor markers, and use tumor markers frequently to follow BC & MBC patients. Information about tumor markers and other pertinent findings must be conveyed to patients in a timely fashion - meaning, as soon as the information has been received. At the very least, any oncologist would agree that this information ought to be shared with patients during routine, scheduled follow-up visits, which given this patients profile, would occur quite often. Earlier treatment and intervention favors the patient in this scenario. I have the expertise to determine if the follow up rendered was inadequate and also assist in determining the extent of injury caused by the delay in treating this patient in a timely manner.
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