Active surveillance does not increase malpractice risk across cancers

Data recently published in the journal Annals of Surgery indicate that there has been no successful malpractice litigation against physicians regarding active surveillance across cancer types, including prostate and kidney, supporting its use as a management option in appropriate low-risk cancers.¹

Overall, the authors concluded that active surveillance is a sound management option for appropriate low-risk cancers and poses no increased risk of malpractice litigation.

Active surveillance is currently recommended by the National Comprehensive Cancer Network as a treatment option for patients with low-risk prostate, kidney, and thyroid cancers, according to a news release on the current study’s findings.² However, given that some patients may experience progression, metastasis, or cancer-related mortality while on active surveillance, the authors noted a significant barrier to active surveillance being a perceived risk of malpractice litigation due to missing the window of cure.

“Our team previously published research showing that active surveillance is an effective treatment for many low-risk thyroid cancer patients. These latest findings show no increased risk of medical malpractice with active surveillance across multiple cancer types,” said senior author Allen S. Ho, MD, in the news release on the findings.² Allen is a professor of surgery, the director of the Head and Neck Cancer Program, and the co-director of the Thyroid Cancer Program at Cedars-Sinai Cancer Center in Los Angeles, California.

For the study, the investigators assessed US-based medical malpractice cases between 1990 and 2022 that involved the use of active surveillance for the management of prostate cancer, kidney cancer, thyroid cancer, breast cancer, or lymphoma. Data were collected from the Westlaw Edge and LexisNexis Advance databases on both civil and federal cases.

In total, 5 prostate cancer cases were identified pertaining to active surveillance. No other cases involving active surveillance were found for the other cancer types included in the analysis.

Of the 5 prostate cancer cases identified, 2 involved an alleged deliberate indifference to active surveillance as a management option, but were ultimately deemed by the court to have followed the appropriate standard of care. The other 3 cases involved alleged physician negligence due to a lack of recommendation for active surveillance following complications from surgery. All 3 cases were ruled in favor of the physicians after they provided documented informed consent from patients regarding the practice.

Overall, the authors concluded that active surveillance is a sound management option for appropriate low-risk cancers and poses no increased risk of malpractice litigation. They also added that failure to discuss active surveillance as a treatment option is just as prone to litigation.

“This data should bolster physicians’ confidence in recommending active surveillance for their patients when it is an appropriate option. Active surveillance maximizes quality of life and avoids unnecessary overtreatment, and it does not increase medicolegal liability to physicians, as detailed in the case dismissals identified in this study. In fact, in some cases, physicians were sued because they didn’t offer active surveillance,” concluded co-author Timothy J. Daskivich, MD, in the news release.² Daskivich is a urologic oncologist and an assistant professor of surgery at Cedars-Sinai Cancer Center.

References

1. Chang S, Daskivich TJ, Vasquez M, Sacks WL, Zumsteg ZS, Ho AS. Malpractice trends involving active surveillance across cancers. Ann Surg. 2024;279(4):679-683. doi:10.1097/SLA.0000000000006101

2. RESEARCH ALERT: Malpractice trends involving active surveillance across cancers. News release. Cedars-Sinai. March 27, 2024. Accessed March 28, 2024. https://www.newswise.com/articles/research-alert-malpractice-trends-involving-active-surveillance-across-cancers