From Breast Cancer Coalition of Rochester
-By Pat Battaglia
The Rochester-born doctor Jennifer Griggs is a medical oncologist the University of Michigan in Ann Arbor and a professor in the Department of Internal Medicine, Hematology/Oncology Division at that facility. While maintaining a practice focused on breast cancer, she co-authored a recent study published in the Journal of Clinical Oncology* entitled Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer, in which researchers came to the conclusion that, although the use of this form of treatment increased between 2003 and 2012, fewer than fifty percent of eligible patients received it. Furthermore, increasing its usage may be important in improving ovarian cancer outcomes. Dr. Griggs kindly agreed to explain intraperitoneal therapy and some of the issues surrounding its use for our readers.
Pat: What is intraperitoneal chemotherapy and under what circumstances might it be recommended?
Dr. Griggs: Intraperitoneal (IP) chemotherapy is chemotherapy administered directly into the spaces surrounding the organs in the abdomen and pelvis after ovarian cancer. It is recommended only for women in whom surgery was successful in removing all or nearly all visible tumor deposits. That is, it is not given if a lot of cancer was left behind after surgery. There are other women in whom IP chemotherapy is not recommended, including women who have a lot of adhesions, or scar tissue, from previous surgeries or pelvic or abdominal conditions such as endometriosis or a ruptured appendix earlier in life. Also, IP chemotherapy is not given alone, but rather along with intravenous (IV) chemotherapy.
Pat: How does the risk versus benefit profile of IP chemo compare to that of IV chemo?
Dr. Griggs: Because most ovarian cancer recurrences happen in the pelvic and abdominal area, IP chemotherapy allows the chemotherapy to be delivered in higher concentrations in the same areas where the disease tends to recur. It does require placement of a catheter to deliver the chemotherapy into the peritoneal cavity, and the catheter itself can cause complications. The chemotherapy itself can be associated with discomfort or pain, although management of symptoms is part of a patient’s care. In addition, the risks of IP chemotherapy may outweigh the benefits in patients who have problems with their kidney function. Finally, patients with IP chemotherapy do not receive IP chemotherapy alone, but rather receive both IP and IV chemotherapy, so it’s not a matter of IP versus IV chemotherapy but rather IV versus IV and IP chemotherapy.
Pat: The report you coauthored concludes that IP chemo may be underutilized among eligible patients. What factors do you feel contribute to this and how might this situation be changed?
Dr. Griggs: Delivering IP chemotherapy is not trivial from the patient’s standpoint or that of the health care team. If the treating physician and the support staff do not believe that the benefits outweigh the risks, it will lead to lower use rates of IP chemotherapy in some centers than in others. It is also possible that patients may decline IP chemotherapy, but the variation seen by treatment setting is not likely due to variation in patient preferences by site. The first step to addressing underuse of IP chemotherapy is making medical providers aware of the underuse of this therapy. Next, physicians and health care teams need to understand and address the barriers to the use of IP therapy. Collaboration between centers that have more experience and those that have less experience is one way to increase the use of this important type of treatment.
Pat: What do patients with ovarian cancer need to know when facing treatment decisions involving IP chemo?
Dr. Griggs: Patients who have had surgery for ovarian cancer need to know if they are good candidates for IP chemotherapy—that is, they need to know if they have had most of the visible tumor removed, they need to know if they have good kidney function, they need to know if the chemotherapy will be able to move around in the space around the organs (that is, is the space free of adhesions), and if their team is experienced with placement and use of the IP catheters. Other good questions would include how symptoms from the IP chemotherapy will be managed and how the risk of infection will be decreased.
Pat: Understanding the issues involved can be so helpful to patients in communicating with their health care team. Thank you, Dr. Griggs, for taking the time to enlighten our readers.