By Ross Walker

The controversy around Sydney St Vincent’s Hospital's chemotherapy treatment has been reignited this week following a report damning this practice, suggesting that the management at St Vincent’s mislead the public and covered up vital information. 

Without wishing to sound like an apologist for St Vincent’s or a blatant defender of the medical profession, of which I am obviously a proud member, I would like to put this situation into some perspective, from my opinion.

This entire issue centres around the specific practices of one oncologist Dr John Grygeil and his particular management of very specific head and neck cancers. Specifically, this is referring to Dr Grygeil’s management of 78 patients with head and neck cancers over the past ten or so years. It relates to ‘off protocol’ dosing in these patients with a chemotherapy drug Carboplatin using a flat or much lower dose of the drug that is typically suggested by the varying drug regimens for this particular condition.

To quote an article by Kate Aubusson in the Sydney Morning Herald recently, ‘St Vincent’s Hospital mislead the public and failed to disclose the seriousness of systemic chemotherapy under- dosing to its cancer patients, a damning report reveals, prompting an unreserved apology from management.’

This may be so, but there is no strong evidence that Carboplatin at any dose has a huge impact on survival or tumour recurrence compared with other treatments available and, in many ways, whether this was a ‘bungle’ as described in news headlines or purely one oncologist’s differing opinion, is a matter of conjecture. The particular oncologist in question was asked about this practice as early as 2005 and nothing was done about it back then. Of the 78 patients treated with this regimen of lower dose Caroplatin, 23 have died from their cancers, which is close to the standard mortality rates for this type of cancer recurrence.

Thus, I am not justifying this particular oncologist’s practice because I am not sure, (and neither can anyone else be for that matter), that his variation from standard therapy has made any difference to patient care.

There is still much debate regarding the benefits of the varying types of chemotherapy for solid, non-hormonal tumours, such as head and neck cancers, but there is no doubt that the higher dose regimens of any chemotherapeutic agents do come at the price of many more side effects. 

Secondly, these types of media reports place fine institutions such as St Vincent’s Hospital in a very bad light, who typically do extraordinary medical research and offer, in almost all cases, excellent evidence based standard of care.

Before we damn this man and St Vincent’s Hospital I would like an independent expert in this area of medical therapy to produce a randomised control clinical trial of higher dose Carboplatin versus the flat dose regimen used by Dr Grygeil for the specific group of patients with head and neck cancers and show that there is a significant advantage to these particular people.

I certainly couldn’t find this evidence but I am not an expert in this area. So, before we damn this man, could someone please produce the evidence.