News on an Unusual Cancer Treatment by Heat in Surgery (Hipec)
There’s so much weird and exciting cancer news this week, it’s hard to keep up!
Double-kudos to Andrew Pollack on his front-page and careful coverage in the New York Times of the hyperthermic intraperitoneal chemotherapy (Hipec) technique that’s being used at some name-brand health care facilities to treat colon cancer.
First, he spares no detail in the Times describing the seemingly primitive, crude method:
….For hours on a recent morning at the University of California, San Diego, Dr. Andrew Lowy painstakingly performed the therapy on a patient.
After slicing the man’s belly wide open, he thrust his gloved hands deep inside, and examined various organs, looking for tumors. He then lifted the small intestine out of the body to sift it through his fingers…
….After about two hours of poking and cutting, Dr. Lowy began the so-called shake and bake. The machine pumped heated chemotherapy directly into the abdominal cavity for 90 minutes while nurses gently jiggled the man’s bloated belly to disperse the drug to every nook and cranny.
As a patient, I have to wonder, who’d sign up for this? And yet it seems they can’t complete a good randomized trial, for patients fear they’ll get the regular treatments only, without the Hipec. As an oncologist, I have to think, how can they possibly do a randomized clinical trial for this sort of method; the results would vary, enormously, from surgeon to surgeon, and from patient to patient – depending on the tumor load and responsiveness to heat, besides all the other tumor variables, even if the Hipec did help a patient or a few.
Pollack supplements the lead story with a shorter piece on hipectreatment.com, a website that obviously promotes the treatment but doesn’t reveal industry ties. According to his article, a competing site, HipecDoctor.com, lists doctors who do it (Hipec), but only includes those who use the site’s sponsoring company’s equipment.
At times like this, Nixon’s “war on cancer” takes on new meaning.
The business of oncology gets messy, on-line and in real patients’ guts. If you ask me, the Hipec approach might be labeled “alternative.” It’s certainly unconventional.
FDA, how do you classify this stuff?
HIPEC Surgery Featured on Grey’s Anatomy (KXLY news clip)
Hard not to contrast the Hipec news with the neatly-designed, high-tech and scientifically-detailed approach published yesterday in the NEJM for treatment of patients with chronic lymphocytic leukemia. That limited but fascinating report, of intense interest to cancer immunologists and gene therapists, serves mainly as proof of principle.
To find out more on Hipec, I intend to watch the segment of Grey’s Anatomy (see one of many related news clip here, scroll down) which may have popularized – and increased demand – for this procedure among desperate patients.
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Ah, the leukemia/gene therapy story: you captured my sentiments exactly! “…limited but fascinating report…serves mainly as proof of principle.”
Now to return to your wonderful Cathy coverage :)
My sister, who had a rare form of appendiceal cancer, had to deal with the HIPEC decision, and ultimately decided against it. Sometimes, though, I wonder if she had done it if it would have made a difference….
Thanks for the tip in the times article. I had missed it.
Hi Peggy,
Every decision is hard when someone’s facing a serious form of cancer. And second-guessing yourself, or a loved one, can be like mental torture.
There’s an op-ed in today’s paper about Hipec – http://nyti.ms/qFogfY by Barron Lerner. His point is that it remains unproved, like many aggressive cancer treatments given with good intention in modern history.
“After slicing the man’s belly wide open, he thrust his gloved hands deep inside, and examined various organs, looking for tumors. He then lifted the small intestine out of the body to sift it through his fingers…” Correct me if I’m wrong but you just described what happens in any abdominal surgery done for cancer! I’d like to know which surgeon worth his/her salt would NOT “sift it through his fingers” (run the bowel)!! Is researching a topic not a prerequisite for journalism any more?
SJS, You’re right, it’s just a graphic depiction of an exploratory laparatomy that appeared in the original NYT article. This sort of description is rare in a news article on surgery.
So I appreciate your comment very much, because it reflects the choices editors and/or authors make that frame a story and influence the reader’s perception of the subject. These words, on routine aspects of the operation, might make the procedure seem more primitive than other abdominal surgeries. But it’s the heated chemo part that distinguishes the Hipec, and not what’s described in this segment.
Absolutely, and as an intern at a large center that treats peritoneal neoplastic diseases, I have “shaked and baked” numerous times….and have seen countless patients go home on a regular diet within a week….and make it to their 5 year follow up appointments. Yes, when used to treat advanced ovarian cancers (in NCCN guidelines), the results are not as good, the disease itself is aggressive and implies end-stage …but with appendiceal cancers where peritoneal spread is the norm, it seems foolish to discard outright the utility of this procedure when it gives patients years of good quality life. And you are right, with a disease incidence of 1-2 per million, a neat and tidy RCT is probably never going to be possible. But in the right hands ie with surgeons on the “good” end of the learning curve HIPEC is definitely worth serious thought. I know I would definitely opt for it if I were to be diagnosed with appendiceal cancer , and not only as a desperate last resort. I only wish editors would think twice about how these articles can single handedly change perception one way or the other, especially when published in such reputed/well-read papers!
SJS, To be clear, I’m not advocating Hipec, just commenting on the writing and how that might influence the reader’s thoughts about the procedure.