University Hospitals Bristol and Weston NHS Foundation Trust

4. Mrs Y complains about the care and treatment provided to her husband Mr Y by the Trust between April and October 2024. Specifically, she says the Trust failed to carry out further investigations in a timely manner following a PET-CT scan which appeared to show a concerning finding.

5. Mrs Y says as a result, the Trust missed an opportunity to make an earlier diagnosis of duodenum cancer and her husband died. She says she firmly believes had the Trust carried out investigations in April 2024 then her husband could have received timely treatment and stood a better chance of surviving.

6. Mrs Y told us she was financially reliant upon her husband, and she will struggle to overcome this. Mrs Y has suffered emotional distress, saying she will never get over the loss of her husband.

7. Mrs Y would like an apology, service improvements and financial compensation.

8. Mr Y was diagnosed with left tonsillar cancer (a type of head and neck cancer originating in the left tonsil) in March 2024 and was treated with chemoradiotherapy. A PET-CT scan (medical imaging used in the detection of cancer) was carried out in April 2024 to assess for signs of metastatic cancer (cancerous cells which have spread from the primary site). The scan showed a lymph node in the back of Mr Y’s abdomen.

9. A further scan was carried out in October 2024 to assess Mr Y’s response to treatment and monitor the abdominal lymph node. In November 2024, Mr Y was told he had inoperable duodenal (part of the small intestine) cancer. Mr Y sadly died on 10 February 2025.

13. Mrs Y told us the Trust failed to carry out further investigations following a PET-CT scan taken in April 2024 which appeared to show a concerning finding in Mr Y’s abdomen.

14. In its complaint response the Trust said after confirmation of Mr Y’s diagnosis of left tonsillar cancer, a PET-CT scan was performed to assess for any metastatic disease, and it identified a small lymph node at the back of the abdomen.

15. The Trust said the primary concern at the time was the urgent treatment of the left tonsillar cancer which required immediate attention and intervention with radical chemoradiotherapy (a treatment approach that combines chemotherapy and radiotherapy).

16. Additionally, the Trust said in May 2024 Mr Y’s case was reviewed in a multidisciplinary team meeting (MDT) and during the discussion it was decided due to the location of the lymph node, it was considered difficult to biopsy at that point, so a scan was requested to be carried out in three months.

17. The Trust said, given the urgent need to focus on the tonsillar cancer, it was decided to monitor the lymph node through follow-up imaging as part of the regular post-treatment surveillance, rather than pursue immediate exploration.

18. We reviewed this issue with the help of our clinical adviser using Mr Y’s medical records.

19. Mr Y’s GP referred him for suspected head and neck cancer on 29 January 2024. He had presented to his GP with a six-week history of persistent sore throat with occasional hoarseness and a lump on his neck. He reported having given up smoking nine years previously but prior to that had smoked up to 60 cigarettes a day. He also reported a four-kilogram loss of weight which was unintentional.

20. Mr Y was seen in the head and neck clinic on 12 February. The consultant ordered urgent imaging and a left tonsil biopsy.

21. Mr Y had MRI and CT scans on 26 February and a biopsy on 11 March. Mr Y’s results showed he had left tonsillar cancer with the tumour extending to the base of the tongue with some spread of cancer to lymph nodes in his neck.

22. Mr Y’s case was discussed in a head and neck MDT meeting on 19 March, and the consultants decided to treat Mr Y with a seven-week course of radiotherapy and concurrent chemotherapy. The consultants requested an urgent PET-CT scan to assess for further metastatic cancer.

23. Mr Y was seen in the head and neck clinic the same day and the consultant gave Mr Y the news the tumour could not be surgically removed but was treatable with radiotherapy and chemotherapy.

24. The PET-CT scan was carried out on 13 April and reviewed by a consultant radiologist on 17 April. The PET-CT scan revealed a small lymph node at the back of Mr Y’s abdomen. The consultant radiologist noted ‘given the patient is to receive chemoradiotherapy and that this lymph node is not easily accessible for biopsy it may be best simply to observe on an early post treatment PET-CT scan.’

25. Mr Y’s case was discussed in a head and neck cancer MDT meeting on 23 April. The abdominal lymph node was discussed with the team, and the plan was to refer Mr Y’s case to the hepato-pancreato-biliary (HPB) team for discussion about how to manage the abdominal lymph node.

26. The HPB MDT meeting was held on 17 May. The HPB MDT reviewed Mr Y’s PET-CT scan and concluded it was not possible to biopsy the abdominal lymph node due to its location.

27. The HPB MDT recommended focusing on treatment of the head and neck cancer and monitoring the lymph node on a PET-CT scan following completion of chemoradiotherapy treatment.

28. A letter summarising the HPB MDT meeting was sent to Mr Y’s GP on 20 May.

29. Mr Y received radical chemoradiotherapy treatment for head and neck cancer from 15 April 2024 until 31 May 2024.

30. Mr Y was seen in the oncology clinic on 15 July. The oncologist recommended a PET-CT scan for the end of September which was four months after the completion of treatment.

31. National Multidisciplinary head and neck cancer guidelines state, ‘follow up for head and neck cancer should include post treatment imaging after chemoradiotherapy, usually by PET-CT scan at three to four months.’ We therefore consider the oncologists decision to arrange a scan four-month post treatment was in accordance with relevant guidance.

32. Mr Y had a holiday booked at the end of September and so it was agreed to perform the PET-CT scan on his return.

33. The Trust carried out the PET-CT scan on 5 October. The scan revealed an excellent response to the treatment for head and neck cancer and there appeared to be no residual disease in that area.

34. The PET-CT scan showed the abdominal lymph node was still visible as was a second lymph node which was not present on the previous PET-CT scan. Further investigations were carried out and sadly, Mr Y was diagnosed with inoperable duodenum cancer which had spread to his liver.

35. Mr Y was incredibly unfortunate to be diagnosed with two primary cancers in the same year. Duodenal cancers are very rare, and Mr Y’s duodenal cancer was aggressive with the rapid development of liver metastases.

36. Our clinical adviser told us it is very challenging to treat two cancers at the same time. There is no specific guidance regarding what should happen when a patient has two simultaneous cancers. The management relies on the expertise and clinical judgement of the relevant MDTs.

37. MDTs are a collaborative group of healthcare professionals who work together to diagnose and develop personalised treatment plans for cancer patients. They have various areas of expertise and are responsible for presenting and interpreting imaging, examining biopsies and coordinating care.

38. Mr Y’s case was considered by the head and neck MDT and then referred to the HPB MDT for its opinion on how to manage the abdominal lymph node.

39. The Trust’s plan following discussion by the head and neck MDT and referral to the HPB MDT to prioritise treating the obvious head and neck cancer was reasonable given the abdominal lymph node was small and not easily accessible for biopsy.

40. GMC’s good medical practice says, ‘you must provide a good standard of care. If you assess, diagnose, or treat patients, you must work in partnership with them to assess their needs and priorities. The investigation or treatment you propose, provide or arrange must be based on this assessment, and on your clinical judgement about the likely effectiveness of the treatment options.’

41. In providing clinical care you must:

• promptly provide suitable advice, investigation or treatment where necessary

• consult colleagues or seek advice from your supervising clinician where appropriate.

42. The Trust focused on the urgent matter of treating Mr Y’s established head and neck cancer with a plan to monitor the abdominal lymph nodes after treatment for head and neck cancer was complete. The decision was made by two different multidisciplinary teams of professionals who agreed this was the appropriate plan for Mr Y. We are satisfied the Trust acted in accordance with relevant guidance when deciding on this plan.

43. We saw the Trust wrote to Mr Y’s GP to inform it of the plan to monitor the abdominal lymph node. We saw nothing in the records however, to suggest the Trust wrote to Mr Y directly to inform him of the plan. We also did not see this plan was discussed with Mr Y in a face-to-face meeting or by telephone.

44. Clinic letter writing guidance states, ‘writing letters directly to patients is in keeping with Good Medical Practice which says you must give patients the information they want or need to know in a way they can understand and the NHS Constitution which states patients have the right to be given information about the test and treatment options available to them’

45. The NHS Constitution also states, ‘staff should involve patients their families, carers or representatives fully in decisions about prevention, diagnosis and their individual care and treatment.’

46. We consider the Trust should have discussed the MDT’s plan with Mr Y to allow him the opportunity to ask questions and be involved in discussion about his care. We also consider the Trust should have written directly to Mr Y to inform him of the MDT discussion and plan for monitoring the abdominal lymph node.

47. Our clinical adviser said had the Trust communicated the results of the April PET-CT scan and subsequent MDT plan to Mr and Mrs Y then this may have helped them in feeling prepared and informed when Mr Y was eventually diagnosed with duodenal cancer. Mrs Y described months of uncertainty and then devastating shock at hearing the terminal diagnosis. A better communicated plan may have alleviated some of their distress.

48. The Trust has agreed to write to Mrs Y to apologise for the impact caused and pay £500. It will also put a service improvement in place by reminding its staff about the importance of involving patients in discussion about their care and writing to them directly.

49. We are satisfied this is an appropriate resolution to Mrs Y’s complaint.

Summary

50. We can see Mrs Y’s complaint deeply affected her. Some things did not happen as they should have in relation to communication. We acknowledge how this has added to Mrs Y’s grief, after Mr Y died. We hope this report reassures Mrs Y the improvements made, will change things for the better.

1. We have carefully considered Mrs Y’s complaint about University Hospitals Bristol and Weston NHS Foundation Trust (the Trust). Having done so, we think the Trust appropriately managed Mr Y’s care and treatment but did not adequately communicate with Mr and Mrs Y about the plan of care.

2. The Trust has agreed to provide an apology, service improvements and financial compensation in resolution to Mrs Y’s complaint.

3. We acknowledge how important Mrs Y’s complaint is to her and recognise this has been a difficult time. We are sorry to hear of Mr Y’s sad death and the impact this has had on Mrs Y.