Reprinted with permission from The Messenger.
By Lori Harrsion, Messenger Staff Writer
After a diagnosis of ovarian cancer, Gayle Hall received standard treatment —then followed her doctor’s advice to go a step further. That step was intraperitoneal therapy, which delivers chemotherapy drugs directly into the abdomen. “It was just to coat the area where I had the cancer,” said Hall, who received the then-experimental treatments the last three months of 2004 at Regional Medical Center’s Merle M. Mahr Cancer Center.
Earlier this year, the National Cancer Institute recommended all physicians begin using IP therapy — in combination with surgery and intravenous chemotherapy — to treat ovarian cancer. The recommendation came after a Gynecologic Oncology Group study showed a 16-month boost in survival rates among patients who received the IP therapy.
Dr. Lynn Parker participated in the research trial as director of gynecologic oncology at the University of Louisville’s Brown Cancer Center, which is affiliated with the Mahr Center. She sees patients once a month in Madisonville.
“After participation in that trial, we’ve continued to do a lot of intraperitoneal therapy because we believe in it,” Parker said. Two previous studies had shown some survival advantage to patients who received abdominal chemotherapy, but the GOG trial was the largest.“Because it’s a difficult therapy to give — it’s more labor intensive, you have more side effects while you’re getting it — it had not previously been embraced very much by the community,” Parker said.
Hall agreed the treatment was more difficult than standard chemotherapy.
“The regular chemo, I didn’t get nauseated,” the 50-year-old Nebo woman said. “I did lose my hair with the regular chemo, but with this chemo, I couldn’t get around and walk because of the weight.” The drugs are pumped into the abdomen, where they remain until they’re absorbed by the body.
“You sloshed a lot,” Hall said, with a laugh. She had been told to expect to gain weight and retain fluid. “The first treatment they gave me, I looked like I was three months pregnant.” She received three treatments, lasting up to 2 1/2 hours each. “You rotate every 15 minutes,” Hall said. “My husband (David) would sit there with his watch and he’d go, ‘Time to turn,’ so I would turn. The nurses would come in to make sure I was turning. They all got a kick out of it and called me, ‘shake and bake.’”
Hall’s battle against ovarian cancer began after she went to work one morning in January 2004 and her left leg quickly swelled to about three times its usual size. After being told by a doctor she had a blood clot, she was sent to RMC’s Heart and Vascular Center for a heart mapping procedure.
In addition to finding the clot, this test found another problem — which was diagnosed as ovarian cancer. “If blood clots are a blessing, that one was,” Hall said. She underwent surgery, then six regular chemo treatments. In October of that year, she started the IP treatments — but not as part of the study. After the third treatment, she was told she was in remission.
While Hall is the only patient to receive IP therapy at the Mahr Center, everything is in place to continue its use here, Parker said.
Typical of women with ovarian cancer, Hall noticed no symptoms before the diagnosis. About 22,220 women in the United States were diagnosed last year with the disease, which is the most deadly cancer of the female reproductive system. The same year, 16,210 American women died of ovarian cancer.
“The life expectancy of someone who has a suboptimal surgery and the cancer comes back, which it’s more likely to do in that setting, is about 1 1/2 to two years,” Parker said. “Cure rates of people who got optimal surgery and chemotherapy are around 40 percent. So when you’re talking about (in the research trial) a survival advantage of 16 months, that’s huge in ovarian cancer.”
The recommendation calls for patients to receive six cycles of IP therapy — which most taking part in the research trial did not get.
“On a research protocol, you can’t give all the supportive things that we normally give to get somebody through chemo,” Parker said. “We can’t give them medicines to help their blood counts. We can’t give them a lot of the nausea medicines that we use every day. So patients get taken off a study because their blood counts are low.”
Studies must be done that way so researchers know the toxicity of the chemotherapy regimen, she said.
Now that the research trial is over and supporting medications can be given, more people are able to receive the full six treatments.
That could be good news for patients and their families, because the 16-month survival advantage shown in the study is based on data from women who generally received only two to four treatments.
“It’s probably going to be even better than that,” Parker said.
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