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HIPEC Specialists
Respond to Critics
PMP Pals' Network
September 2, 2011
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Patients and Physicians Support HIPEC
Patients and surgeons alike responded to another disconcerting article about HIPEC, posted in the NYT recently, this time penned by Dr Barron Lerner.
Dr Lerner expressed a variety of concerns regarding HIPEC, the specialized treatment embraced my many of those of us who have, or are suffering from peritoneal surface malignancies and cancers of the digestive system.
His concerns and subsequent remarks generated an influx of calls and emails to the Pals' desk, ranging from dismay to outrage.
While drafting my initial letter of reply to the editor of the NYT (Appendix Cancer Patients Want HIPEC Treatment) several HIPEC treatment specialists around the world shared their own comments with the Pals.
Today, we have selected to post comments from two of those surgical oncologists, as well as Dr Lerner's reply to my letter to him.
In closing today's issue of PMP Pals I reference my final response to Dr Lerner (A Patient's Defense of HIPEC)
PMP Pals will feature several articles describing the risks and benefits of HIPEC, throughout the fall season, as numerous surgeons will be sharing their observations and reports with our readers.
Today's issue features remarks by renowned surgeons,
Dr Jan Franko and Dr Brian Loggie.
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Dr Jan Franko
Mercy Medical Center, Des Moines, Iowa
Jan Franko, MD, PhD, FACS shares his comments regarding
Dr Lerner's article, as follows:
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Dr Jan Franko
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"CRS-HIPEC is considered a gold standard in certain European countries, e.g. in France (Elias 2010). Given the very poor prognosis of peritoneal carcinomatosis (Franko ASCO 2011 and pending full JCO publication), HIPEC is currently considered by many the best treatment option available and is endorsed by a number of leading American surgical oncologists (Esquivel 2007). CRS-HIPEC has substantially better quality of supporting evidence as compared to liver resection for colorectal liver metastases - a practice done for over 50 years, and accepted only in last 2 decades. Since CS-HIPEC is much 'younger' modality, it will probably take additional time to acceptance. CRS-HIPEC is the only modality associated with prolonged survival, even disease-free survival in some patients. This remains true for appendiceal cancer as well as colorectal cancer, peritoneal mesothelioma, and is increasingly studied in gastric cancer. Similar results have not replicated by systemic chemotherapy. Currently, there are no other treatment options. Either way, the true question should be WHO should receive WHAT therapy and in WHICH sequence. With all due respect to NYT contributors, I don't think we can answer this question through the NYT opinion pages. We have better chance to solve it in doctor offices, research labs and in peer-reviewed publications." Jan Franko, MD, PhD, FACS Surgical Oncology & Endocrine Surgery Mercy Medical Center Click here for more information about Dr Franko's research |
Dr Brian Loggie
Creighton University, Omaha, Nebraska
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Dr Brian Loggie
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"There are many studies documenting benefit for IPHC/HIPEC. Before cytoreductive surgery (CRS) with HIPEC, peritoneal carcinomatosis (PC) was uniformly fatal in less than two years. Critics argue that patients may fare better with systemic chemotherapy treatment and leap to the conclusion that they may not require CRS+HIPEC. What is not mentioned is that these patients would likely require continuous, expensive systemic chemotherapy for the remainder of their lives. "PMP" is a little harder to analyze because of longer survival after suboptimal treatment of low grade disease. In our practice we see survivors that are more than 5 years out (post-surgery and HIPEC) and "cured". The nature of the beast is that these tumors want to re-implant and are likely disseminated by extensive surgery. HIPEC was rationally designed to take this into account and is a relatively inexpensive cancer therapy when added to surgery." Brian W. Loggie, MD, CM, FRCSC, FACS
Chief, Division of Surgical Oncology
Creighton University Medical Center
Click here for more information about Dr Loggie's research |
Dr Barron H Lerner
Columbia University Mailman School of Public Health,
New York
On August 31, Dr Lerner shared this statement with Gabriella.
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Dr Barron Lerner
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"Ms. Graham--
Thank you for your e-mail. Having written extensively, and approvingly, on the history of patient activism, I greatly appreciate your comments. There are numerous examples of patients pushing for procedures that eventually turned out to be effective.
My purpose in writing this op-ed was to respond to the recent reports that Hipec, formerly used for the rare cancers you mention, is now being used for much more common cancers where data are sparse.
The earlier New York Times article estimated that the use of Hipec may soon go from 1,500 to 10,000 cases annually. And medical centers are advertising it aggressively to attract business. These were the big red flags for me.
Although you and others have helped to publicize data for appendiceal cancers, no such resource exists for the thousands and thousands of ovarian and colon cancer patients who may soon be offered the treatment. Indeed, the positive results you have cataloged for rare cancers may mistakenly be taken as relevant for these other, unrelated, cancers.
Faced with this situation, I felt it was important to reflect on other aggressive, expensive treatments that took off like wildfire and were eventually shown to be of no value. I am all for patients being proactive. They just should not confuse that with improved outcomes.
I wish, in retrospect, I had made the above points more clearly in my article. I was careful to mention only ovarian and colon cancers, not appendiceal cancer. But I might have made this distinction more clearly.
I hope this addresses your concerns. Please feel free to share this e-mail with others and good luck to all of you."
Best,
Barron Lerner
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Gabriella Graham
Patient
Here are my final comments that I shared with Dr Lerner:
A Patient's Defense of HIPEC, Part II
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Gabriella
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We welcome your comments!
 Click here to submit your comments/questions! We welcome your feedback! |
Pals Celebrating Life! Rene is a HIPEC patient! 
Rene, Suzanne and Sons Celebrate Summer!
Last year Rene was recuperating from CRS and HIPEC.
This summer he is enjoying the beautiful countryside of the Netherlands during summer vacation!
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Are you enjoying a vacation with your family this month? Send your vacation and celebration photos to pmppals@yahoo.com Click here to view more pix of Pal families around the world! |
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The PMP Pals' Network is a member of ASPSM
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Editor and Publisher:
Gabriella Graham, Patient
Advisory Council:
Susan Cardy, OCT, Hons. BA, BEd, Canada, Family Caregiver
Sara Shatford Layne PhD, United States, Family Caregiver
Edward F Maguire BA MHA FACHE, United States, Cancer Survivor
Ulrike Mandigo, RN, Germany, Family Caregiver
Marilyn Price, BA Ed Ad, Australia, Patient
Sandra Rhodes, MS, United States, Family Caregiver
AC Roemhild, United States, Cancer Survivor
Brian B Spillane, MS, United States, Cancer Survivor
Jeanie Sutherland, RN, United Kingdom, Cancer Survivor
Copyright 2011 by the PMP Pals' Network. All rights reserved.
Serving Patients, Families and Healthcare Providers
in 48 Countries
1998-2011
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