A 75-year-old man died from metastatic pancreatic cancer while in lawful custody. He was diagnosed in February 2025 and underwent palliative chemotherapy at Prince of Wales Hospital from March-April 2025. He developed anorexia, nausea, and diarrhoea after his second chemotherapy cycle, experienced clinical deterioration, and was transitioned to end-of-life care. He died following a respiratory infection and sudden hypotension. The coroner found that his medical conditions were appropriately managed by Corrective Services NSW and Justice Health staff, with no evidence that different management could have materially changed the outcome. Death was from natural causes related to advanced metastatic pancreatic cancer.
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Specialties
oncologypalliative caregeneral medicine
Drugs involved
gemcitabinepaclitaxelantibiotics
Clinical conditions
metastatic pancreatic adenocarcinomapancreatic cancer with liver metastasespancreatic cancer with lung metastasesrespiratory infectionischaemic heart diseaseatrial fibrillationasthma
Procedures
pancreatic biopsypalliative chemotherapyend-of-life care management
Contributing factors
advanced metastatic pancreatic cancer with liver and lung metastases
respiratory infection
chemotherapy-related adverse effects including anorexia, nausea, and diarrhoea
clinical deterioration following second cycle of chemotherapy
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