In the United States, an estimated 21, 290 new cases of ovarian cancer are expected to be uncovered in the coming year. According to the American Cancer Society, 14,180 women- more than half of those patients affected with ovarian cancer- are expected to die. Out of all types of cancer, ovarian cancer is the fifth largest cause of death for women. One out of seventy-five women are diagnosed with ovarian cancer, and the chance of any single woman dying from ovarian cancer is one out of one hundred. Unfortunately, less than half (45.6%) of women diagnosed with ovarian cancer survive five years after cancer development.
The New York Times recently published an article discussing what Dr. Maurie Markman, the president of medicine and science at the Cancer Treatment Centers of America, called “tragic”. The tragedy that Markman is referring to is that an effective ovarian cancer treatment is enormously under utilized in American hospitals around the nation. In 2006, the National Cancer Institute announced a new treatment for ovarian cancer- a treatment they believed should have been integrated into medical protocol immediately. This new treatment required that instead of only intravenously (through the veins) pumping chemotherapy into ovarian cancer patients, doctors should actually pump chemotherapy directly into the patient’s abdomen, which is known as intraperitoneal (IP).
An impressive study published by oncologists from the GOG (Gynecologic Oncology Group) in the New England Journal showed that IP chemotherapy could add at least sixteen extra months to those suffering with ovarian cancer. Additionally, a study showed that even ten years after treatment with IP, risk of death for patients with ovarian cancer was reduced by twenty- three percent in comparison to those treated with regular chemotherapy.
While it sounded like this chemotherapy practice would become popular and widespread, in the past ten years less than half of ovarian cancer patients have been treated using IP. A recently published study in the Journal of Clinical Oncology analyzed six elite hospitals that specialize in “high quality cancer care”. Sadly, even in these specialized health centers, IP rates have been quite low. According to this study, when the New England Journal of Medicine published their results on IP in 2006, the rate of IP
treatment rose from zero to thirty- three percent. In the next two years, from 2007-2008, IP treatment rose to fifty percent. However since 2008, four to sixty- seven percent of patients have been treated with IP.
This is the case in the most elite cancer hospitals. In lower quality hospitals, the rate of IP treatments is much lower. Dr. Alexi Wright, a medical oncologist at the Women’s Cancer Center in Boston, voiced shock at the low rate of IP treatment. She said that “we suspected that even at the best centers there would be low integration of IP chemotherapy, but we were surprised to see how low it was across academic centers, and also to see how much variation there was between centers…It’s (IP) the best data we have for improving survival among patients with this cancer.”
Why is it that a novel cancer therapeutic, that has been proven to extend the life of ovarian cancer patients, is so underused? The New York Times explored this issue and a few possible reasons have been suggested. First, some experts believe that IP is more difficult to administer than regular chemotherapy IV. In addition medical personnel are worried IP is too toxic for the body. Astonishingly, another rationale suggested was that IP is not lucratively beneficial to doctors as it time consuming and includes the usage of generic drugs from which oncologists make little profit. Dr. Markman suggested that this type of new treatment is unique, as it does not involve a new drug or device. Generally if a new medical practice is introduced the practice needs to be taught extensively in order to be effectively introduced into common medical protocol. Since IP does not include a new drug or device, medical personnel are less educated about IP. If the proper education were provided it would require large amounts of time and money.
Despite all of these justifications, Dr. Deborah Armstrong, a professor at John Hopkins Kimmel Cancer Center and a leading researcher of the positive effects of IP, states that seeing all the consistent evidence of the life extending results of IP, oncologists can make “no more excuses” for not treating patients with IP. Hopefully, as more awareness is raised for IP treatment more patients suffering with ovarian cancer will be treated with IP and thereby given the chance to live longer lives.
http://corporate.dukemedicine.org/news_and_publications/news_office/news/9434