09  Jan  14 erin-stevens category Erin Stevens

Are We Measuring Correctly? | Erin Stevens, MD

Metrics are becoming very important in the treatment of cancer. As physicians, we want to know that all patients are being given the correct treatments for their disease. We can measure this by using databases and codes. Nationwide, we use these metrics as a way to tell us how far we have to go get all patients to receive the standard of care. We also have metrics on end of life care and things we should avoid with our cancer patients, including hospital admissions and chemotherapy in the last two weeks of life. But sometimes numbers do not tell the whole story.
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04  Apr  13 eijean-wu category Eijean Wu

A View from the Trenches | Eijean Wu, MD, MPP

The line starts forming outside the building around 6:00 a.m. When I walk from the parking lot to the cafeteria to get my morning coffee, I see my patients, crowded under the awning, ready for the monthly ritual of coming to a county cancer clinic. Many of them have bags packed with magazines and snacks. Some are holding sleeping grandchildren. I marvel at how they have adapted their lives to a clunky bureaucracy that doesn’t respect their time.

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14  Mar  13

Ellen J.Sullivan, MS, MSJ
Director of Corporate Communications and Advocacy

Bathing abdomen in chemotherapy gives ovarian cancer patients better chance of survival

More Women Should Receive Intraperitoneal Treatment, Suggests 10-Year Follow-up

LOS ANGELES (March 9, 2013)– Patients with advanced ovarian cancer who undergo intensive treatment with chemotherapy that bathes the abdomen are significantly more likely to live longer than those who receive standard intravenous (IV) chemotherapy, according to a study that analyzed long-term follow-up from two landmark Gynecologic Oncology Group (GOG) trials comprising 876 patients. Results of the study are being presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer in Los Angeles, March 9-12.

Women who receive the treatment in the form of intraperitoneal, or IP chemotherapy are 17 percent more likely to survive longer than those who have IV chemotherapy, according to the analysis, which had a median follow-up of more than 10 years. Median survival was more than five years (62 months) for patients in the IP group and about four years (51 months) for patients in the IV group. Median is defined as the number separating the upper and lower half of a study population.

The findings also suggest women who complete most or all of the recommended six cycles of IP therapy are likely to live longer than women who complete four or fewer cycles. After five years, 59 percent of patients who completed five or six cycles of IP therapy were alive, compared to 33 percent of those who completed three or four cycles and 18 percent of those who completed one or two cycles. Patients who are unable to receive the full six cycles of IP therapy typically transition to IV chemotherapy for the remaining cycles.

“Too many women do not receive an explanation about the advantages and disadvantages of IP therapy and that it could be a potential life saver,” said Devansu Tewari, MD, Director of Gynecologic Oncology for the Southern California Permanente Medical Group in Orange County, Calif., of Kaiser Permanente and Assistant Professor of Obstetrics and Gynecology at the University of California, Irvine School of Medicine. “But there is also a caution that it should be administered by a physician who has expertise in the treatment and can best manage the risks and side effects.”

Every year, more than 22,000 women are diagnosed with ovarian cancer and more than 15,000 die of the disease. In standard IV chemotherapy, the drugs are infused into the bloodstream and throughout the body, whereas IP treatment directs the chemotherapy to the abdomen. This not only places a high concentration of cancer-killing drugs where they are needed, but the chemotherapy agents are absorbed more slowly, providing more exposure to the medicine. IP is recommended by the National Cancer Institute for women who have had optimal surgery.

Because IP therapy is more rigorous, some of the side effects are also more intense, such as numbness in the hands and feet and abdominal pain, and some women are unable to complete the suggested six cycles of therapy. Researchers found younger, healthier patients were more likely to complete more cycles of IP.

Funded by the National Cancer Institute, the Gynecologic Oncology Group comprises experts in the field, from gynecologic oncologists to nurses to scientists, who are committed to maintaining the highest standards in clinical trials. The GOG focuses its research on women with pelvic malignancies, such as cancer of the ovary, uterus and cervix.

“There is no question IP therapy should be much more widely offered, and advanced ovarian cancer patients should consult with gynecologic oncologists or medical oncologists with experience in this cancer who have the expertise to determine the best therapy,” said Dr. Tewari. “At the very least, these women should be treated by someone who has experience with IP therapy issues and knowledge of whether she would be a good candidate.”

About SGO

The Society of Gynecologic Oncology (SGO) is a 501(c)6 national medical specialty organization of physicians and allied health care professionals who are trained in the comprehensive management of women with malignancies of the reproductive tract. The Society’s membership, totaling more than 1,600, is primarily comprised of gynecologic oncologists, as well as other related medical specialists including medical oncologists, radiation oncologists, nurses, social workers and pathologists. SGO members provide multidisciplinary cancer treatment including chemotherapy, radiation therapy, surgery and supportive care. www.sgo.org


08  Feb  13 b-j-rimel category B.J. Rimel

‘Is my chemotherapy vegan?’ | B.J. Rimel, MD

BJ Rimel_headshot 2“Is my chemotherapy vegan?”

Despite my 12 years of post-graduate training, I was completely floored by this question.  To be honest, my initial response was not what it could have been.

“I have no earthly idea,” I said, in my best doctor voice.  I left the clinic feeling completely incredulous that anyone with a life-threatening cancer would care if their chemo was in any way associated with animal products.  As a new attending, I initially felt righteous that I had not given in to a long discussion about non-evidence based treatments, and instead steered our conversation back to symptom management, dosing schedule and a review of the side effects she was likely to experience.

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