C ancer patients suffer through treatment in the hope that it will be worth it -- so it’s disconcerting to consider that mistakes may get in the way. A recent study that reviewed the medical charts of nearly 1,500 patient visits from four different cancer clinics around the country found many errors. Published in the Journal of Clinical Oncology, the study reported that there was a 7% error rate for adult cancer patients receiving medications as outpatients -- and a dismaying 19% error rate for children. (The majority of these pediatric errors occurred at home, mostly due to confusion about administration or dose.) 

Kathleen E. Walsh, MD, of the University of Massachusetts Medical Center, led an independent team of doctors that reviewed charts from three adult and one pediatric clinic, three of which were community-based clinics that were part of larger medical centers and one run by an academic medical center. The team also reviewed data from in-home treatments as well.

Four different types of errors were identified:

• Drug ordering -- those made by doctors in ordering medications.

• Dispensing -- mistakes made by pharmacy workers in giving out medications.

• Administration -- errors made by nurses giving medicines at the clinic or by patients or family members giving medicines at home.

• Monitoring -- oversights by doctors, nurses or at-home caregivers in checking for physical changes in patients.

For adults, a common source of errors was nurses who were administering medicines in the clinic. For children, a common error that had great potential for harm was in erroneous administration of medication at home. Chemotherapy regimens can be very complex, with lots of different types of medicines being given in varying amounts at different times, especially in children who take liquid medicines or pills. Dr. Walsh told me that parents too often don’t call to find out what to do when problems arise at home, but instead wait until the next appointment.

Overall the outpatient oncology clinics had an 8% medication error rate. These results point very clearly to important advice for people who want to derive the greatest benefit from their cancer treatment. If you or a loved one is being treated for cancer, always-always-always double-check dosing instructions and medications before giving. "Ask, ask, ask," advises Dr. Walsh. Ask the name of the drug... the amount to be given... the name of the doctor who signed the orders... and the date of the orders. And if anything at all seems unclear, ask the outpatient staff to check back with your doctor.