David Kevin Loader, a 58-year-old life prisoner, died from metastatic cancer of unknown primary in January 2020. He presented with multiple episodes of back, abdominal, shoulder and rib pain between July and November 2019, initially attributed to musculoskeletal causes including a prisoner-administered 'chiropractic' injury. Weight loss of 9.4 kg was documented in November. CT scan on 29 November 2019 revealed widespread metastatic disease in vertebral column, liver and bones. Expert review concluded the cancer likely developed in October-November 2019 and there were no clinical presentations that should have prompted earlier investigation or diagnosis. The coroner found the standard of care was excellent, comprehensive and appropriate, with dignity afforded throughout his final weeks of life in prison hospice.
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Specialties
general practiceoncologypalliative careneurologyphysiotherapy
metastatic cancer of unknown primarycarcinomatosisepilepsycerebral palsydepressionhepatitis Cpulmonary embolushypercalcaemiaintraepidermal carcinomadermal melanocytosis
Procedures
CT scancolonoscopygastroscopyradiotherapy
Contributing factors
metastatic cancer development during October-November 2019
multiple non-specific presentations of pain in various anatomical locations
initial attribution of pain to musculoskeletal causes
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