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It’s a treatment that can raise the dismal survival rate from ovarian cancer by 10 percentage points, but most women who should be getting it aren’t.
A new study shows just 41 percent of eligible women are getting chemotherapy delivered directly to the affected area, even though the benefits are so strong that the National Cancer Institute has made a rare recommendation for doctors to use it.
The therapy involved infusing strong chemotherapy drugs directly into a patient’s abdomen alongside more traditional intravenous infusions.
It’s not as easy as just showing up once a week or so to sit in a chair for a few hours. Patients have to be admitted to the hospital to get it. But a 2006 study showed that adding the extra infusion — called intraperitoneal chemotherapy — adds 16 months to the average patient’s life.
"We found that only 41 percent of women who were eligible for this treatment were getting it."
Dr. David O’Malley, a gynecologic oncologist at Ohio State University, and colleagues wanted to see if doctors were adding this extra step. They studied the records of 823 women treated at six hospitals that are part of the National Comprehensive Cancer Network — hospitals that are supposed to be at the leading edge of cancer treatment.
They chose the facilities because they have the staff, equipment and know-how to deliver the treatment, they reported in the Journal of Clinical Oncology.
They found only a third of women got the abdominal infusions before 2006. It spiked to 50 percent between 2007 and 2008, but gradually leveled off after that.
“The problem is, when we looked at six of the largest academic medical centers in the country, we found that only 41 percent of women who were eligible for this treatment were getting it. That needs to change,” O’Malley said in a statement.
At some hospitals, just 4 percent of women who should be getting the therapy actually received it, O’Malley found. The best rate among the six centers was 67 percent.
“Our results suggest that the use of IP/IV chemotherapy may also be influenced by local culture and clinical practice leaders’ enthusiasm for treatments and clinical trial,” they wrote.
“Fewer than 3 percent of adult patients with cancer enroll onto clinical trials, and trial participation may be associated with better survival outcomes,” they added.
In a clinical trial, doctors test new treatments against older treatments. With cancer, patients are guaranteed to get at least the very best current standard of care, and may also get a new, experimental treatment on top of it. But few sign up for it.
"The use of IP/IV chemotherapy may also be influenced by local culture."
Doctors have studied why women are not getting the double chemo treatment for ovarian cancer. The reasons include side-effects, inconvenience, patient preference and the lack of clear guidelines for how to deliver the treatment.
O’Malley’s team said they didn’t find much difference in side-effects.
Not everyone's eligible for the extra treatment. This study looked at women with Stage 3 ovarian cancer, which has spread, but not throughout the whole body yet.
The researchers' suggestion: Patients should ask doctors if they could consider the intraperitoneal therapy. And institutions should review their practices.
Ovarian cancer kills almost all its victims. It comes back after the first treatment in 80 percent of women, according to the National Cancer Institute. It will be diagnosed in more than 21,000 American women this year and it will kill more than 14,000.
The latest approach uses immune therapy, but old-fashioned chemotherapy is still the usual first line of treatment.
Ovarian cancer's been in the headlines over the past year because actor and director Angelina Jolie announced she had her ovaries removed surgically to avert her very high risk of ovarian cancer. Jolie, who inherited DNA mutations that put her at high risk, also had both breasts removed two years ago.