Causation: The Key Element of Oncology Litigation

All successful medical negligence claims require four cardinal elements: duty, breach, harm, and causation. In oncology litigation, however, the element of causation assumes paramount importance. The reason is that many tumor processes are lethal within a defined period of time independent of brief delays in diagnosis or debatable errors in treatment. This fact often forms the foundation of solid defense theory though it frequently blind-sides an ill-prepared plaintiff.

The key to utilizing a causation argument is to first fully understand the specific characteristics of the tumor. These tumor traits determine how aggressively a tumor will attack its host which in turn dictates the overall prognosis. The most relevant tumor-specific characteristics are identity, stage, and doubling time.

The tumor identity is the most important trait since it determines the overall prognosis. Benign tumors (e.g. cerebral meningioma) are typically non-aggressive, less invasive, and not prone to recurrence. Malignant tumors (e.g. squamous cell lung cancer) typically attack in an aggressive and invasive fashion, often with a tendency to metastasize and recur. Although imaging studies may provide compelling evidence of the presumed tumor type, only a tissue biopsy analyzed by a pathologist can determine the specific identity.

Tumor stage is another critical prognosticator that essentially describes how aggressively the tumor has behaved. There are numerous staging systems for specific tumor types, though the most common system for the staging of solid tumors is the TNM system. “TNM” (standing for Tumor, Nodes, Metastases) describes the size of the tumor, the involvement of nearby lymph nodes, and the presence of tumor that has spread from the original site. In general, “favorable” tumors are those identified at an early stage — small size and no spread beyond the tumor itself.

Doubling time, a measure of how quickly a cluster of tumor cells doubles in mass, is another key factor in determining prognosis, thought it is not necessarily calculated for many tumor types. When determined, it does provide insight into how aggressively a tumor may behave.

In litigation, tumor identity, staging, and doubling time all come into play in building or defending a causation argument. For example, if a specific tumor type has a dismal prognosis (e.g. pancreatic cancer), then a delay in diagnosis may have been inconsequential. If a tumor already presented in an advanced stage with metastasis, then an error in management may not necessarily affect the outcome. If a tumor has a defined doubling rate, then it may be possible to extrapolate forward or backward to determine the stage of the tumor at various points in time — a critically important task that can make or break causation.

Only an experienced, Board-Certified oncology medical expert witness can credibly evaluate these complex variables. Without a thorough understanding of the oncologic basis of causation, it is impossible to develop a strategic plan or to predict the outcome of a cancer-based claim.

To learn more about Oncology and Oncology expert witnesses, you may view our Oncology Expert page.

To consult with an ELITE physician or nurse about your next Oncology case, please feel free to contact us at any time for a complimentary consultation.

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