Experts on medical legal trends associated with active surveillance

In this video, Allen S. Ho, MD, and Timothy J. Daskivich, MD, MSHPM, discuss the background and notable findings from the recent study, “Malpractice trends involving active surveillance across cancers.” Ho is a professor of surgery, the director of the head neck cancer program, and a co-director of the thyroid cancer program at Cedars Sinai Medical Center in Los Angeles, California. Daskivich is a urologic oncologist in the Cedars-Sinai Urology Academic Program and the director of Health Services Research for the Cedars-Sinai department of surgery.

Video Transcript:

Ho: Active surveillance, as we know it in oncology, is a minimalist treatment option for certain cancers that are unlikely to cause harm or be lethal. It has been widely adopted in national treatment guidelines. There exists high level evidence supporting it as a sound and appropriate treatment option in selected low risk cancers. This includes prostate cancer, thyroid cancer, lymphoma, kidney cancers, and others. One gap is that adoption practice of surveillance has been somewhat haphazard across cancers, depending on the cancer type. We actually feel that one of the reasons for this discrepancy and a key barrier to adoption to active surveillance is perceived fear on the part of physicians for malpractice. We wanted to see if that was indeed the case. Given that there have been decades of experience with active surveillance, we wanted to see if there was indeed any truth underlying the possibility of malpractice for physicians that practice active surveillance.

Daskivich: Physicians who are considering recommending active surveillance to their patients sometimes have a lot of concerns about medical legal ramifications if the cancer should progress while the patient is on surveillance. While we have data suggesting that active surveillance is very safe, there will be patients who will progress. In prostate cancer, the rate of progression to metastasis at 15 years approximately double that of patients who are getting upfront surgery and radiation. That data is from randomized controlled trial from the ProtecT trial. So, there will be a small proportion of patients that will progress on active surveillance. This study was intended to see if there were any successful medical legal cases that patients brought against physicians that held physicians liable for the progression that occurred while they were on active surveillance. This medical legal concern may dissuade physicians from recommending active surveillance. What we found was that there were no successful lawsuits that were prosecuted against physicians because they recommended active surveillance to patients. In fact, we actually found that there were more lawsuits that were directed at physicians who did not recommend active surveillance when it was an appropriate treatment strategy. So, we hope that the results of this study will reassure physicians that there will not be medical legal ramifications if they recommend active surveillance their patients in concordance with guidelines.

This transcription has been edited for clarity.