Ovarian cancer is one of the most common cancers women get (and more than 14,000 women are expected to die from it in 2015, according to the American Cancer Society). But new research indicates that an overwhelming majority of American doctors aren't using intraperitoneal/intravenous (IP/IV) chemotherapy, a treatment that's been shown to be effective at treating this killer disease.
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In 2006, The National Cancer Institute issued a rare "clinical announcement" (a special alert released only when a new finding is so important that medical practice should change accordingly) saying that a combination of having chemotherapy pumped directly into the stomach and administering in the typical intravenous way could add at least 16 months to patients’ lives. Based on their findings, the organization encouraged the use of this treatment, known as IP/IV. The treatment is effective, says Andrew Berchuck, M.D., director of gynecological oncology at Duke Cancer Institute, because the chemotherapy is administered directly into the peritoneal cavity (a fluid-filled gap between the walls of the abdomen and the organs in there), the site of much of the cancer, rather than into the much farther away arm.
In this new study published on August 3 in Journal of Clinical Oncology, the authors looked at data based on 823 women with stage III ovarian cancer who were being treated at six National Comprehensive Cancer Network institutions from 2003 to 2012. They examined the use of IP/IV chemotherapy in these women and then selected a smaller subgroup of these women and compared the outcomes of IP/IV chemotherapy vs. just the use of chemotherapy via an IV. All of the women had had surgery before getting treatment.
Perhaps most significantly, the study's researchers confirmed previous research that IP/IV patients lived longer than those who just received an IV of chemo, finding that 81 percent of the former were alive after three years, compared to 71 percent in the latter group. That being said, the researchers also found that at six elite cancer hospitals in the U.S. studied over a nine-year period, fewer than 50 percent of ovarian cancer patients received the treatment, and at least one of the individual hospitals used the treatment in as few as four percent of their patients who were candidates for it.
This begs the question: Why aren’t doctors administering IP/IV chemotherapy to more ovarian cancer patients?
There are a few reasons: According to this new study, one potential barrier is a fear of treatment-related toxicities. The study authors noted that there were more cases of anemia and hospitalizations in the women who had IP/IV chemotherapy vs. intravenous chemo. Berchuck says IP/IV can be harder to handle than just an IV: It can cause more nausea and vomiting, higher rates of nerve damage, and more discomfort at the site where it's administered. Therefore, he says only the most fit and able patients should receive the treatment.
Yet another possible explanation for the underuse of IP/IV treatment is lack of access to gynecological oncologists, who tend to be concentrated in larger cities. Berchuck says that many women end up going to medical oncologists for chemotherapy, and they may be unfamiliar with administering IP/IV.
The study authors do admit that there were some limitations to their findings: One, they weren’t able to compare the survival rate differences between different IP/IV chemotherapy regimens. Two, they weren’t able to include patients who received dose-dense paclitaxel (a medication used to treat various forms of cancer). If that had been included, the survival rates between IP/IV chemotherapy and intravenous chemo may not have differed quite as much, they wrote in their findings.
But overall, the researchers concluded that IP/IV is an effective yet possibly underused treatment for improving the outcome of ovarian cancer patients. Hopefully, their research will get people talking—and ultimately, save more lives.