Half of doctors don t use life-extending technique for ovarian cancer: Why?

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A new study of combination intra-abdominal and intravenous chemotherapy for advanced ovarian cancer confirmed its significant benefits in terms of survival. So why aren t more Stage III and IV cancer patients getting this effective therapy? A combination of ignorance and greed seems likely.

Ovarian CancerThis year, over 21,000 new cases of ovarian cancer are expected in the United States, and over 14,000 deaths. Once ovarian cancer has spread within the peritoneal cavity or to other organs, long-range survival is extraordinary. However, shorter-term benefits can be obtained via several different chemotherapy regimens.

Clinical trials dating back almost 20 years have consistently demonstrated a survival advantage in advanced ovarian cancer treated with IP/IV (intraperitoneal/intravenous) chemotherapy, as compared with standard IV only chemo. In 2006, a large study known as GOG-172 (Gynecologic Oncology Group) demonstrated a 16-month improvement in median overall survival. A new study just published in the Journal of Clinical Oncology confirms the superiority of the combined IP/IV approach. But data collected from six National Comprehensive Cancer Centers Hospitals showed that the combination approach is only being utilized by slightly less than half of the oncologists patients who are candidates for it.

The study was performed by a multi-center group of researchers led by Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston, and was also published in the Journal of Clinical Oncology. They examined IP/IV chemotherapy use in all patients (823) diagnosed between 2003 and 2012, and evaluated overall survival and treatment-related toxicities in a sample (402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias.

They determined that the use of IP/IV chemotherapy increased, (most likely) as a result of the 2006 publication of the GOG-172 study, from 0% in 2003 to 50% in 2008, and plateaued thereafter; 43 percent of patients received modified IP/IV regimens at treatment initiation. IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%), compared with IV chemotherapy.

The authors concluded that although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.

An article in the New York Times by Denise Grady on this study and topic speculated on some possible reasons why this beneficial treatment method is being under-utilized: Experts suggest a variety of reasons that the treatment is so underused: It is harder to administer than intravenous therapy, and some doctors may still doubt its benefits or think it is too toxic. Some may also see it as a drain on their income, because it is time-consuming and uses generic drugs on which oncologists make little money.

Those possible rationales for not giving late-stage ovarian cancer patients state-of-the-art treatment are quite simply unacceptable. Another word of advice from the Times/Grady article is this: Patients have to be more proactive and forceful. They should ask if their doctor uses the IP/IV treatment, and if he or she does not, they should seek another doctor.