Treating Cancer : An Imperfect Protocol

"I was 37 years old, and I was seven months pregnant when I was diagnosed with a rare breast cancer.  It's called inflammatory breast cancer.  The day I met with my oncologist she had explained to me what dosage was the correct dosage for me, so I trusted her.  I actually got a second opinion, and the second opinion said the same thing.  Same dosage, everything.  So I went through and did everything that I was supposed to do, everything that they told me to do, that's what I did.  Then I heard that the chemo that I had been doing had been diluted."
"It was after my treatment.  Within 6 months my cancer was showing back up on scans, and had spread.  I was devastated because I thought I did everything.  What more could I have done?  I changed my diet, I did all the chemo they said, I did all the radiation, I did everything everyone told me to do, but my cancer was back.  And then I got a letter that said the chemo you had done had been diluted."
"What I've learned is that they have this percentage that says that the chemo is still adequate within these certain percentages.  The inquiry that was done after said that the chemo is still effective, even with the dilution.  What I don't understand is, why now do we not now have that same dilution rate?  They would be saving money.  But instead they actually spent more money to make sure these things don't happen again. "
"I am not well.  I've had over 200 rounds of chemo now, and 50 rounds of radiation, multiple surgeries.  Cancer may not kill me but the chemo will probably kill me soon.  And that's where I have a problem.  The $1,500 dollars I'm not sure is worth how much I've gone through.  Maybe my cancer would have come back.  It's quite possible it would have come back.  But had it been maybe six months later, maybe if my drugs weren't diluted I could have had six months extra with better health.  What's that worth?  What's a day of better health?"
Sarah Johnson, cancer patient, CBC interview, December 2016

Sarah Johnson is among the approximately 1,200 cancer patients in Ontario and New Brunswick who received diluted doses of chemotherapy drugs in 2012. (Amy Dodge/CBC)

"I'm in pieces about it."
"We [cancer patients who received diluted chemotherapy drugs] were hoping for better news."
"I laid my heart out in court and it didn't seem to make any difference."
Louise Martens, Windsor cancer patient

"[The terms of the settlement] are fair, reasonable and in the best interests of the class [action suit] members, as a whole, and the settlement is, hereby approved."
"At its core, this action is about people -- cancer patients and their families; some of whom feel betrayed by the medical system they relied on; some of whom experienced anxiety over their future outcome; and some of whom sincerely believe that their own condition has worsened or that they have lost a loved one, either sooner than they otherwise would have, or at all, because of the dosing incident."
"That is not the case [that some settlement objectors claim their lives have little value reflecting the settlement amounts]. Indisputably, the value of 'the life' of each class member is immeasurable. The terms of the settlement do not suggest otherwise, and they do not reflect an attempt to value 'the worth' of any class."
Ontario Superior Court Justice Gregory Verbeem

"Because overwhelmingly the class members supported this settlement [I am satisfied with its outcome]."
"Effectively, we would have been blown out of the courtroom, and to get this money from the defendants was a remarkable set of negotiations."
"Understandably, people who've lost loved ones can't get hold of the reality that they were going to die anyway. Sad but true."
Harvey Strosberg, Windsor lawyer representing some under-dosed cancer patients

One imagines that any lawyer representing a class action suit would express his professional pride in the outcome that recognizes some level of fault, while side-stepping responsibility for that fault's minimal impact on the unfortunate outcome which doctors attribute in large part to the disease's trajectory. And given that assurance by cancer specialists that the amount of the deficiency in the active drugs' presence in the chemotherapy mixture could not have accounted for a deleterious outcome, the presiding judge would be amenable to presenting the legal decision as fair.

A horrendous scandal hit the airways and print media in 2012, when it was revealed that close to 1,200 cancer patients in Ontario and New Brunswick hospitals who had received chemotherapy treatment for their various cancers, were given diluted doses of their intended chemotherapy medication. The news story reflected a measure of inattention bordering on incompetence which has been characterized as 'miscommunication' lest blame come down too heavily on anyone responsible.
Some of the patients involved, decided to take part in a class action suit.

That class action suit representing 1,194 patients involved in the diminished chemotherapy drugs treating their cancers sought compensation reflecting the negligence seen to have been perpetrated by those whose profession it is to look after the well-being of patients. A settlement was worked out between lawyers representing the patients, and those representing the companies and hospitals involved in the provision and use of the diluted chemotherapy drugs.

Mezentco Solutions Inc. was responsible by contract for the supply of pre-mixed intravenous chemotherapy treatments to a number of hospitals in Ontario and New Brunswick. The lawsuit named the hospitals and as well a consortium, Medbuy, that the hospitals had set up to purchase medical products in high volumes at reduced prices to try to keep expenses under control. The reduced percentage of drugs in the chemo mixes was estimated at between seven to ten percent less than prescribed.

Of the 290 cancer patients who received the drugs by intravenous treatment at Windsor Regional Hospital in 2012 and 2013, over 70 have since died of their cancers. The settlement money works out to just over $1,500 to be awarded to each of the patients. The presiding justice made note that 49 objections had been filed against the settlement. Some 95 percent of the total number of patients had not filed objections.

 Last November, they received a compensation offer of $2.3 million, or about $1,500 for each patient.  But some who received the diluted doses felt the settlement is not nearly enough. The total is to be divided so that $1.8 million goes to the cancer patients, lawyers are to receive $400,000, $75,000 represents administrative costs, while the Ontario and New Brunswick governments are to be disbursed $100,000 each.

Justice Verbeem was in agreement with patients' lawyers who felt the agreement had been negotiated in good faith and its outcome exceeded their expectations, had they proceeded to trial since there existed a clear lack of evidence to demonstrate that the under-dosing that occurred via the diluted drugs had a clearly defined deleterious effect on patients' treatment of their cancers.

Preparing chemotherapy IV bags ((CBC))