This was published 7 years ago
Dr John Grygiel stands by chemotherapy dosing at St Vincent's Hospital
By Kate Aubusson
The oncologist accused of underdosing more than 100 cancer patients has stood by his treatment decisions, suggesting the current dosing guidelines may have caused them more harm, a parliamentary inquiry has heard.
NSW cross benchers grilled senior medical oncologist Dr John Grygiel on Tuesday over his off-protocol chemotherapy dosing for more than 100 patients with head and neck cancer at St Vincent's Hospital in Sydney and outreach clinics in Orange and Bathurst.
Dr Grygiel suggested other doctors at St Vincent's hospital may have followed the same low-dose regimen for the chemotherapy drug carboplatin, which is at odds with current clinical guidelines.
The retired clinician also contradicted statements made by his colleagues during an earlier hearing on Monday, and claimed his superior suggested he take early retirement to avoid a "shit storm".
Dr John Grygiel at the parliamentary inquiry on Tuesday. Credit: Peter Rae
Dr Grygiel said there was no evidence that the guideline dose would have led to better outcomes for his patients.
"Indeed, in many cases, I believe it would have led to a negative impact as it would have discouraged patients from continuing treatment," he said.
"I have devoted my entire career to the ethical treatment of cancer patients ... I very much regret the distress my patients have suffered as a result of the publicity surrounding these inquiries," he said.
Opposition health spokesman Walt Secord accused Dr Grygiel of carrying out clinical trials on cancer sufferers by ignoring treatment guidelines.
Greens Health spokesperson Jeremy Buckingham, whose mother-in-law's cancer treatment was overseen by Dr Grygiel, challenged Dr Grygiel as to whether he had ever asked her: "Do you want to die with your hair?"
Dr Grygiel denied both accusations, telling the inquiry that he discussed several treatment options with all his patients and obtained informed consent in every case.
"I have always been open and honest in my discussion with my patients, families and my colleagues concerning their treatment," Dr Grygiel said.
"You have to realise, maybe I'm not the only person who uses those sorts of dosing," he said.
"In making preparations for the HCCC [Health Care Complaints Commission] investigation [I was] asked to review 84 patients from a St Vincent's cohort and two of those patients weren't mine."
On Monday, a colleague and senior clinician told the inquiry that he had spoken to Dr Grygiel over concerns of flat dosing in June 2015.
But Dr Grygiel said his colleague did not approach him to discuss the issue, and senior staff had not previously expressed concerns over his dosing regimen and knew of his flat dosing since 2006.
Dr Grygiel said he was told in a meeting by his superiors that an internal investigation had "exonerated him".
"I was completely blind-sided on the 18th February [2016] when the issue [was made public]," he said.
Dr Grygiel said the only inkling he was given was a phone call from the hospital's director of cancer services, Professor Richard Gallagher, in February.
"He wanted to talk to me about whether I would take earlier retirement because it would avoid, in his words, a shit storm," Dr Grygiel said.
Dr Grygiel did not accept the characterisation of his treatment as underdosing or sub-optimal.
"Guidelines are important but the weight given to guidelines depends on the level of scientific evidence behind them," he said.
Dr Grygiel adopted flat dosing in 1987, citing research published that year.
He said flat dosing was a "default" option, considering the robustness of the evidence of drug effectiveness.
Challenged over his decision to prescribe carboplatin instead of the guideline-backed cisplatin, Dr Grygiel said authors of a meta-analysis suggested cisplatin appeared to be more toxic and may not be more beneficial for patients over 60 and patients with comorbidities.
He added patients under 60 with no comorbidities had opted for the flat dosing on his advice after presenting several options.
Dr Grygiel said it was not usual practice in multidisciplinary meetings to discuss patient dosing.