By: Jean Johnson for Uterus1
A day in the life might not be much to worry over one way or the other, but when the physicians in charge of your failing health start talking in terms of a year to 16 months, it gets your attention.
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Women with ovarian cancer frequently have no symptoms or only mild symptoms until the disease is advanced. [See ”Ovarian Cancer – A Silent Killer of Women” ]
An estimated 22,220 women in the United States were diagnosed with ovarian cancer in 2005.
The disease causes more deaths than any other cancer of the female reproductive system, with an estimated 16,210 women dying from ovarian cancer in 2005. Ovarian cancer has a considerably higher death rate than breast, colon, or prostate cancer.
At issue is treating advanced ovarian cancer in which the tumors have been successfully surgically removed. The news is that by using a full bore infusion of chemotherapy drugs delivered both intravenously (or IV) and piped directly into the peritoneal cavity of the abdomen itself – called IP for intraperitoneal – specialists can give women get a new lease on life.
In a move not seen since 1999 when it publicized a major advance in cervical cancer treatment, the National Cancer Institute (NCI), part of the National Institutes of Health, issued an early January 2006 announcement alerting patients and encouraging physicians to heed the latest research. The results of the study on IP chemotherapy and ovarian cancer will be published in an upcoming issue of the New England Journal of Medicine.
What is Old is Now New
Deborah Armstrong, M.D., medical oncologist and an associate professor at Johns Hopkins Kimmel Cancer Center in Baltimore was lead researcher in the latest study and indicated that while physicians have know about IP chemotherapy for years, they have tended to dismiss the approach because it is considerably more complicated and also because they did not appreciate its full efficacy.
“IP therapy is not a new treatment approach, but it has not been widely accepted as the gold standard for women with ovarian cancer,” said Armstrong. “There has been a prejudice against IP therapy in ovarian cancer because it’s an old idea, it requires skill and experience for the surgery and for the chemotherapy, and it’s more complicated than IV chemotherapy.”
Armstrong goes on to comment on the recent study results. “But now we have firm data showing that we should use a combination of IP and IV chemotherapy in most women with advanced ovarian cancer who have had successful surgery to remove the bulk of their tumor.”
Phillip DiSaia, M.D., a colleague of Armstrong’s in the NCI-supported research network known as the Gynecologic Oncology Group that participated in the research, noted that the study, which came on the heels of numerous others, was a credible one. “Randomized, multicenter clinical trials, including this most recent study, clearly show the value of IP chemotherapy – an extended life for women with advanced ovarian cancer.”
National Cancer Institute Takes Strong Stance
According to David Trimble, M.D. of the NCI, “We want to use the bully pulpit of the National Cancer Institute to say that patients and doctors need to be aware of this information. There are no big pharmaceutical companies knocking on people’s doors to tell them about” the IP chemotherapy, he said.
Higher ups in the NCI and its umbrella organization underscore Trimble’s observation.
“Americans look to NCI – and to all of the institutes that constitute the National Institutes of Health – for unbiased research studies and sound counsel. This clinical announcement is a demonstration of that commitment,” said NIH Director Elias A. Zerhouni, M.D.
Similarly, the Director of NCI, Andrew C. von Eschenbach, M.D., noted that “The National Cancer Institute wants to make certain that the results of clinical research are rapidly disseminated to both health care providers and patients, in order to ensure that life-enhancing cancer treatments are widely available.”
Close-up of Study Results and Life Extension Expectations
“In our trial, women who received part of their chemotherapy via an IP route had a median survival time 16 months longer than women who received only IV chemotherapy,” said Armstrong.
Armstrong also told the New York Times that often what happens is that patients are operated on by surgeons that do not specialize in gynecologic oncology. This can result in what Armstrong terms a “peek and shriek” operation. In these instances, insufficiently trained surgeons simply see numerous tumors and do not realize that hope exists. Instead they simply close the patient up and go out to deliver doomed pronouncements to the family.
It doesn’t have to be this way in Armstrong’s view. Her study treated 205 women with the IP therapy. Even though, according to the NCI, “complications associated with the abdominal catheter used to deliver the IP chemotherapy” prevented all but 86 of the women from completing the course of six treatment sessions, results still demonstrated IP therapy vastly preferable. Indeed, the results were so impressive that even women who did not have all six treatments benefited.
“It’s really the best news we’ve had in some time,” said chief of gynecologic oncology at Memorial-Sloan Kettering Cancer center in New York, Richard Barakat. “Advanced ovarian cancer is a bad disease. Many patients don’t do well. When you have a study that shows a 16-month prolongation of median survival, that’s a big deal.”
Access to the Procedure
Although the IP therapy has been used relatively rarely to date, the Memorial Sloane-Kettering Cancer Center is one facility where it is already standard procedure. The NCI provides a listing of other medical centers where patients can take advantage of this state-of-the-art technology by clicking here or calling: (800) 4-CANCER.
Experts further add that physicians who are not specialized enough in this area to provide IP chemotherapy need to refer their patients to those practitioners and medical centers that can.
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