A woman with multiple sclerosis died of undiagnosed cancer despite seeing a neurologist and GP regularly up until her death, a WA coronial investigation has heard.
An inquest into the 2014 death of Pamella Rees was told that her symptoms of metastatic cancer of unknown primary origin could have been explained by her other illnesses, including MS, emphysema and trigeminal neuralgia.
The woman, who had MS since 1991, had persistently rejected offers of care from MS organisations and palliative care services and preferred instead to be cared for at home by a friend who was increasingly unable to cope, the inquest heard.
She was seeing a GP regularly to obtain medications for her pain and to control her MS symptoms, but he said the woman’s condition had appeared stable on her last visit, 28 days prior to her death in June 2014.
The GP said he had little experience in the management of MS as she was his only patient with the condition, and he had expected the patient’s neurologist to be providing discussions about life expectancy and palliative care.
However the woman only saw her neurologist, Dr Susan Ho, at six monthly intervals and this was primarily to obtain medications such as Avonex, Lyrica and Tegretol, the inquest heard.
Ms Rees last saw her neurologist about four months before her death, at which time it was considered that the Avonex injections had stabilised her MS and there was no obvious progressive deterioration. The woman had said she was feeling better apart from a recent flare up of her trigeminal neuralgia.
The neurologist had previously referred the woman to MSWA (Multiple Sclerosis Society of WA) to provide support, but attempts to provide home visits by nurses and social workers had been strongly rejected, by the women telling them they could “stuff” their services. Similarly, after initially accepting some help from palliative care group Silver Chain the patient had refused visits from their nurses.