When the National Cancer Institute made a “clinical announcement” in 2006 in favor of a somewhat controversial form of chemotherapy — injecting cancer-killing toxins directly into the abdomens of women with ovarian cancer — more uptake by doctors was expected.
It was the medical equivalent to the Good Housekeeping Seal of Approval, after all, and it was based on a compelling finding: ovarian cancer patients lived, on average, 16 months longer when receiving abdominal chemo compared with standard treatment.
The chemo “sticks around longer” when dispensed through a port into the abdomen, explained Dr. Cheryl Bailey, a gynecologic oncologist with Minnesota Oncology.
As expected, thousands more ovarian cancers each year were treated with intraperitoneal, or IP, chemotherapy instead of standard intravenous, or IV, chemo that injected the medication into the blood stream.
A study in this August’s edition of the Journal of Clinical Oncology showed that 50 percent of women with ovarian cancer who would be ideal candidates for IP chemo actually received it at 26 of the nation’s most prestigious cancer centers.
But Bailey has taken a glass-half-empty view. IP chemo is more complicated and time-consuming, and in its early days sometimes resulted in infections at the port sites through which medication was administered. But nearly a decade after the National Cancer Institute announcement, and plenty of time to perfect its administration, Bailey expected far more women with ovarian cancer to be receiving IP chemo. “It kind of peaked,” she said.
The August study showed variation among the centers — with 4 percent of eligible patients receiving it at one center, and 67 percent at another.
Bailey acknowledged that IP chemo requires more visits and can be harsher on fragile patients. So some of the variation might be explained by patients refusing it.
“Sometimes these folks are quite ill and they’re barely going to hang on with regular chemo — much less something that is a lot more toxic,” she acknowledged.
Skeptics have feared it is underused because it uses older chemo drugs that aren’t as profitable for cancer centers. One solution would be a public quality measure that grades doctors on how often they use IP chemo correctly.
Bailey said the study simply is a “wake-up call” for doctors to reconsider the technique and for eligible patients to at least be asking: “Is there a reason why I wasn’t offered IP?”