This isn't an article about a miraculous cure for ovarian cancer. It's about a way to extend life, in many cases, by about a year, without using larger doses of drugs or increasing radiation. It's about a method that's, sadly, largely ignored.
Ovarian cancer is a particularly insidious disease. Its early stages often do lead to symptoms, contrary to popular belief, but nothing that can't be interpreted as several of a number of other, far less serious diseases. The cancer generates biomarkers that can be measured with blood tests, but these biomarkers can also indicate other kinds of cancer or no cancer at all.
By the time ovarian cancer is finally diagnosed, it is usually too late to treat it. In the United States alone, epidemiologists estimate that more than 21,000 women will be diagnosed with the disease and approximately 14,180 will die of it. Most American women do not receive a life-extending treatment for ovarian cancer, however, that can add an average of 16 months to their lives.
Not A Recent Innovation In Cancer Treatment
What is this innovation in treating ovarian cancer? It is not an especially complicated technique. As far back as the year 2006, the (US) National Cancer Institute took the rare step of making an "important clinical announcement," advising doctors of a change in treatment methods so significant that they should modify their treatment protocols for ovarian cancer immediately. A major study had found that pumping the standard chemotherapy drugs for ovarian cancer directly into the peritoneum (the membrane lining the abdomen), rather than through a vein in the arm, could add more than a year, 16 months on average, to the lives of women who were diagnosed with the disease and being treated for it.
Cancer experts urged that the method of administering chemo be used for women ovarian cancer immediately.
Nearly 10 years later, fewer than half of American women who were diagnosed with this form of cancer were getting their chemotherapy intraperitoneally, through a port in the abdomen. Every year, thousands of years of life are needlessly lost because of these outdated treatment practices. As Dr Maurie Markman, president of medicine and science at Cancer Treatment Centers of America, told the New York Times, "It's unfortunate, but it's the real world. To call the situation 'tragic' would be fair."
Why Don't Oncologists Use Intraperitoneal Administration Of Chemotherapy?
A cynical, but probably accurate, understanding of the reason due to which more oncologists don't give chemotherapy for ovarian cancer through an abdominal port is that it doesn't make them more money. This recommended method of administering chemotherapy to women who are being treated for ovarian cancer uses generic anti-cancer drugs that cost less, on which the cancer clinic makes a smaller profit. It takes more time to administer chemotherapy this way, and insurance companies don't compensate doctors or cancer clinics for the additional time required for the procedure. It also takes clinical skills that some nurses don't have. To adopt this method more widely, additional training of the workforce would be required.
Because the technique to administer treatment to ovarian cancer patients doesn't involve new medications or new instruments that can make pharmaceutical companies or medical device makers more money, no one is eager to make sure clinic staff are educated to be able to give the treatment in this way.
Even worse, there are some hospitals and cancer treatment centers that don't use the recommended treatment method at all. Among "prestigious" hospitals, from just 4 percent to 67 percent of women with ovarian carcinoma get their chemotherapy in this recommended way, and the smaller the hospital, the less likely it is that a patient will get chemo through this method. What can women who have ovarian cancer do to make sure that they get not only the right chemotherapy but chemotherapy in the right way, as they need it?
What Women Receiving Chemotherapy for Ovarian Cancer Need to Do
To put the matter frankly, any woman who has been told she needs to go on chemotherapy for ovarian cancer needs to ask for "abdominal" or "intraperitoneal" administration of the drugs. If the doctor says no, then she needs to look for a different doctor. The eventual outcome for this kind of cancer often is death.
However, when ovarian cancer patients are able to get their chemo in this way, they are a little less than 15 percent more likely to survive to the three-year mark after diagnosis, and up to nearly 50 percent less likely to suffer complications from their treatment.
What do women need to know when they choose to receive chemo for ovarian cancer? Here are some key points.
- In ovarian cancer, the most effective treatment is both cancer-specific and site-specific. The drug needs to be specific to ovarian cancer, not some other kind of cancer. That's rarely a problem with modern cancer treatment. Doctors have access to and choose appropriate medications. Where treatment is likely to be deficient is that usually chemo is not site-specific. The cancer-fighting drug needs to be delivered to the cancer, not to the entire body.
- The most common route through which ovarian cancer spreads is through the intraperitoneal, or abdominal cavity. Giving chemotherapy directly in the path of the cancer is the best way to stop its spread.
- Intraperitoneal chemotherapy results in fewer side effects from the treatment, because the drug is concentrated in cancer tissues, and is found in much lower concentrations in the bloodstream. The rest of the body gets a lower dose of the drug, which means that the patient will feel less unwell.
- Intraperitoneal chemotherapy needs to be given by doctors and nurses who are specialists in gynecological cancers. Inexperienced providers may give ineffective treatment.
- Some oncologists mistakenly believe that abdominally-administered chemotherapy has only been tested in clinical trials. As the study cited below shows, it has been used in hospitals all over the United States for nearly 20 years already.
- Some oncologists are concerned about complications of site-specific treatment. Toxicity is actually greater in the abdomen than it is with conventional treatment. This makes accidents (perforating the bowel, cutting a blood vessel) more serious. This is another reason women should seek out providers who have experience with this method, as well as a reason for which doctors may avoid choosing it.
- The benefits of abdominally administered chemotherapy are not just in the short-tem. Nearly 20 percent of women who get chemotherapy through this method live 10 years after their diagnosis.
There are some limitations to this method of treating ovarian cancer. It does not work as well in older women. It not work as well in recurrences of cancer, although it may still be preferable to other methods. Women who have scar tissue from abdominal surgery may not be good candidates for the technique. Surgery alone is almost never enough once ovarian cancer has spread, and some form of chemotherapy will relieve pain and extend life.
The common chemotherapy drug Adriamycin (doxorubicin), added when ovarian cancer has begun to spread, can have devastating effects on the heart. Make sure you understand the implications for heart health before you begin treatment. The bottom line, however, is that this form of chemotherapy is usually preferable to the venous route. You owe it to yourself to find a doctor who will explore the possibilities of using it.
Sources & Links
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Michael A. Bookman, Robert A. Burger, David E. Cohn, Mihaela C. Cristea, Jennifer J. Griggs, Nancy L. Keating, Charles F. Levenback, Gina Mantia-Smaldone, Ursula A. Matulonis, Larissa A. Meyer, Joyce C. Niland, Jane C. Weeks and David M. O'Malley. Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer. Presented, in part, at the 50th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 30-June 3, 2014.
- Photo courtesy of dayblakelydonaldson via Flickr: www.flickr.com/photos/thespeakernews/20663715639
- Photo courtesy of kalidoskopika via Flickr: www.flickr.com/photos/kalidoskopika/2022600825