you are concerned about the chemotherapy treatment you or a family member has received, please call the Cancer
Inquiry Line on 02 6369 8808 or email
Click on one of the questions listed below for more information about the report into
off-protocol prescribing of chemotherapy.
What is the NSW Health Section 122 report into off-protocol prescribing of chemotherapy?
In February 2016, the NSW Government commissioned an Inquiry into the prescribing of chemotherapy at St Vincent’s
Hospital by Dr John Grygiel, a senior staff specialist in Medical Oncology, from June 2012 to June 2015.
In April, the NSW Health Section 122 Inquiry was expanded to include patients of Dr Grygiel who were treated in
Western NSW Local Health District between January 2006 to June 2015.
The latest report details the findings for the patients in Western NSW Local Health District. The report is
What is off-protocol prescribing?
Chemotherapy is usually prescribed in a customised way based on clinical trials. NSW Health recommends these
protocols and the Medical Specialist applies them to the patient at the time of treatment.
Off-protocol prescribing means that the prescription for a chemotherapy drug has been provided that does not match
This can happen for various reasons, including: a patient’s age or other medical problems, the intent of treatment
such as minimising treatment toxicity and, maximising quality of life.
It is the role of the Medical Specialist to use their specialised expertise to offer the best treatment to the
Who has been affected?
Dr John Grygiel provided fly in-fly out medical services for Western NSW Local Health District from 1989 to March
Some patients treated by Dr Grygiel between January 2006 and March 2013 at clinics at Bathurst and Orange have been
identified as having variations in their treatment from what was considered protocol at the time. These variations
could include things like dosage or drug type.
Western NSW Local Health District has contacted, or made significant attempts to contact, all the known patients
who were identified by the inquiry as having an anomaly with their treatment. The Health District is actively
investigating the specific impact of these concerns on a case-by-case basis.
There may be other patients of Dr Grygiel in the community who have been affected by off-protocol prescribing
What types of cancer treatments were investigated in the report?
The inquiry looked at the prescribing of chemotherapy by Dr John Grygiel, including patients treated in Western NSW
Local Health District from January 2006.
The report considers three types of chemotherapy drugs prescribed by Dr Grygiel to treat a range of cancers. These
drugs were: carboplatin, cisplatin and capecitabine
What cancers are treated with these drugs?
These chemotherapy drugs are used to treat a variety of cancer types, but their use has primarily been for head and
neck cancers, lung cancers, and for cancers of the bowel.
How many people in Western NSW Local Health District have been identified as receiving off-protocol chemotherapy?
The report considered four groups of patients for review:
- A random sample of
patients from Bathurst (56 people) and Orange (61 people)
- People treated with the
chemotherapy drug carboplatin or cisplatin (41 people)
- 21 patients were
treated with carboplatin and five were identified as receiving an off protocol low, flat dose.
- 20 patients were
treated with cisplatin, no variations were identified for these patients.
- People treated with the
oral chemotherapy drug capecitabine (97 people)
- 23 patients were
identified as receiving off-protocol treatment.
- Patients or their families
who contacted the Western NSW Local Health District with concerns about their treatment following the
announcement of the Inquiry (16 people)
- Two patients were
identified as receiving off-protocol treatment.
- Another six patients were
followed up by local oncologists with five receiving ongoing treatment by their oncologists
There may be other patients of Dr Grygiel in the community who have been affected by off-protocol
Are there any more patients affected by
off-protocol prescribing following the Section 122 Inquiry?
In an attempt to identify all patients that had been prescribed Carboplatin
and Capecitabine by Dr Grygiel in our District, we requested information from the Commonwealth Department of Health
Pharmaceutical Benefits Scheme (PBS). This was initially for Capecitabine as most patients received outpatient
prescriptions that they took to their local pharmacy for dispensing. The data received from the PBS identified those
patients that had Capecitabine dispensed so that we could cross match those names with our patients. These patients
are being reviewed for off-protocol prescribing practices and patients and/or their families contacted if there is
an issue to discuss.
What can I do if I am concerned about my own cancer treatment?
Patients who were treated by Dr Grygiel at Clinics at Bathurst or Orange between January 2006 and March 2013 are
encouraged to contact the Cancer Inquiry Line on 02 6369 8808 or
if they wish to have their treatment reviewed.
What support is available for patients and their families?
If any patients or their families require assistance or support, or would like to talk with someone about their
concerns, they can call the Cancer Inquiry Line on 02 6369 8808 for a confidential conversation. Support is offered
to all patients or their families that we speak to.
Should I be concerned if I received care by a doctor not listed in this report?
This report only considered patients of Dr John Grygiel. If you do have concerns, please contact the Cancer Inquiry
Line on 02 6369 8808.
The Ministry of Health is conducting the NSW Cancer Audit to review the range of cancer services offered in NSW.
What is the NSW Statewide Cancer Audit and what
does it cover?
The NSW Ministry of Health is undertaking a Statewide audit of cancer services in NSW Health, This is a sample
audit of patient’s care across the Surgical Oncology, Medical Oncology & Haematology and Radiation Oncology
disciplines. It is a sample across all cancer types and all doctors treating cancer patients in NSW Health. It is
expected to conclude by 30 June 2017.
What should I do if I was treated by Dr Grygiel after 2006?
Patients who were treated by Dr Grygiel between January 2006 and March 2013 are encouraged to contact the Cancer
Inquiry Line on 02 6369 8808 if they wish to have their treatment reviewed.
What will be done to make sure this doesn’t happen again in the future?
The Western NSW Local Health District is deeply sorry and disappointed that this has occurred. Western NSW Local
Health District is adopting all of the recommendations made in the report. This process is underway.
Since 2015, all Western NSW Local Health District oncology patients are included in an electronic oncology medical
record system that confidentially monitors and keeps a comprehensive record of their treatment. Each Oncology unit
now has an Oncology Pharmacist checking chemotherapy prescriptions. In addition, the local Oncology team review all
chemotherapy protocol variations to ensure that chemotherapy dosing is appropriate.
Western NSW Local Health District is proud to have developed and matured its cancer treatment services to deliver
exceptional care for patients closer to their homes. The past decade has seen unprecedented investment in
infrastructure, services and facilities in Western NSW Local Health District which has allowed the Western NSW Local
Health District to transition from being reliant upon fly in fly out specialist services, to providers of locally
based, trusted cancer services
Is the Western NSW Health S122 report publically available?
Yes, it is publically available. Please click here .
The NSW Parliament also established a Legislative Council Select Committee
on Thursday 11 August 2016 to inquire into and report on off-protocol prescribing of chemotherapy in NSW including at St Vincent's Hospital, St George Hospital, Sutherland Hospital, Macquarie University Hospital and clinics in Orange and Bathurst. The final report from this committee was released on Thurday 18th May 2017 and can be downloaded here