Lifesaving Ovarian Cancer Chemo Treatment Underutilized, Study Finds

Women with advanced ovarian cancer who receive intraperitoneal and intravenous (IP/IV) chemotherapy — treatment delivered directly into the abdomen, along with the usual intravenous method — have significantly better survival rates than those who receive IV chemotherapy alone.

The evidence of this is so convincing that in 2006, when a major study showed that the IP method could add 16 months or more to women’s lives, the National Cancer Institute issued a rare recommendation that signified the urgency of changing medical practice to reflect the research.

Yet, today, nearly a decade later, just 41 percent of eligible women are receiving IP chemotherapy, according to a study published Monday in the Journal of Clinical Oncology.

The study looked at IP treatment use at six cancer hospitals, all members of the National Comprehensive Cancer Network, from 2003 to 2012, and at patient survival rates. Alexi Wright, M.D., of Dana-Farber Cancer Institute in Boston, and colleagues, analyzed the records of 823 women with Stage 3, optimally cytoreduced ovarian cancer.

The researchers found the 3-year overall survival (OS) was 81 percent among women who received a combination of IP and intravenous (IV) chemotherapy versus 71 percent for patients who received only intravenous chemotherapy. IP/IV therapy use increased briefly after 2006, but overall use among eligible women was 43 percent from 2006 to 2012, they wrote in the Journal of Clinical Oncology. Rates varied drastically from one hospital to the next, with 4 percent to 67 percent of patients receiving IP treatment — and at smaller, less prestigious hospitals, the rates are even worse, say the researchers.

Wright told The New York Times, “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.”

Reasons for why IP/IV chemotherapy is so underused include toxicity; inconvenience of an inpatient regimen; and a lack of standard guidelines for how to deliver the treatment and train others, which takes time and money.

This year, 21,290 new cases of ovarian cancer are expected in the U.S., and 14,180 deaths, according to the American Cancer Society.

Further recommended reading: Lifesaving Chemo Tx for Ovarian Cancer Often Ignored, MedPage Today