Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Obstetrics and Gynecology, St. Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway.
Acta Obstet Gynecol Scand. 2020 Nov;99(11):1546-1553. doi: 10.1111/aogs.13930. Epub 2020 Jun 18.
In Norway, all patient-reported claims for compensation are evaluated by The Norwegian System of Patient Injury Compensation (NPE). The number of claims from women with cervical cancer is rising, and the approval rate is high. Our aim was to study claims for compensation from women with cervical cancer to identify the type of failures, when, during the time-course of treatment, the medical failures occurred, and the consequences of the failures.
A retrospective, descriptive study of claims for compensation to NPE from cervical cancer patients during a 12-year period, from 2007 through 2018. We used anonymized medical expert statements and summaries of NPE cases.
In all, 161 women claimed compensation for alleged medical failure related to cervical cancer. Compensation was approved for 100 (62%) women. Mean age at the time of alleged failure was 37.5 years (SD ±9.9). The main reasons why women sought medical attention were routine cervical screening (56%), or vaginal bleeding or discharge (30%). In approved cases, incorrect evaluation of cytology and histology was the cause of most failures (72%). Mean delay of cervical cancer diagnosis for approved cases was 28 months (SD ±22). Treatment not in accordance with guidelines was the cause of failure in 2% of the cases, and failure during follow up was the cause of failure in 12%. Consequences of the failures were as follows: worsening of cancer prognosis (89%), treatment-induced adverse effects, such as loss of fertility (43%) and/or loss of ovarian function in premenopausal women (50%), and permanent injury after chemo-radiation (27%). Seven women (7%) died, most probably as a consequence of the failure.
The main cause of medical failure in women with cervical cancer was incorrect pathological diagnosis. The main consequences of failures were worsening of cancer prognosis and treatment-induced adverse effects. Increased focus on the quality of pathological examinations, and better routines in all parts of the cervical examinations might improve patient safety for women in risk of cervical cancer.
在挪威，所有患者提出的赔偿申请都由挪威患者伤害赔偿系统（NPE）进行评估。因宫颈癌向 NPE 提出赔偿申请的女性人数正在增加，且赔偿批准率较高。我们的目的是研究宫颈癌患者的赔偿申请，以确定失败类型、治疗过程中何时发生医疗失误以及失败的后果。
这是一项回顾性描述性研究，对 2007 年至 2018 年间向 NPE 提出的宫颈癌患者赔偿申请进行了调查。我们使用了匿名的医学专家陈述和 NPE 病例摘要。
共有 161 名女性因宫颈癌相关医疗失误提出赔偿申请，其中 100 名（62%）女性获得赔偿。据称发生失误时的平均年龄为 37.5 岁（标准差±9.9）。女性寻求医疗关注的主要原因是常规宫颈筛查（56%）或阴道出血或分泌物（30%）。在获得赔偿的病例中，细胞学和组织学检查错误是导致大多数失误的主要原因（72%）。获得赔偿的病例中，宫颈癌诊断的平均延误时间为 28 个月（标准差±22）。2%的病例因治疗不符合指南而导致失误，12%的病例因随访期间失误而导致失误。失误的后果如下：癌症预后恶化（89%）、治疗引起的不良影响，如生育能力丧失（43%）和/或绝经前女性卵巢功能丧失（50%）以及化疗和放疗后永久性损伤（27%）。有 7 名女性（7%）死亡，最有可能是因失误导致的。
宫颈癌女性医疗失误的主要原因是病理诊断错误。失误的主要后果是癌症预后恶化和治疗引起的不良影响。增加对病理检查质量的关注，并改进宫颈检查各个环节的常规操作，可能会提高宫颈癌高危女性的患者安全性。
