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Health and medicine

Cancer treatment pits pain against payoff

A new, aggressive attack on ovarian cancer is tough on cancer - and on some patients, too. "I would do it again," says one.

By LISA GREENE
Published January 15, 2006

Linda Childs' cancer announced itself suddenly. She woke up one spring morning and decided she looked as if she had swallowed a basketball.

Within a few days, she was diagnosed with ovarian cancer and scheduled for surgery.

Nearly six years after her diagnosis, she is alive. But it came with a price.

A groundbreaking new cancer treatment offers more hope for patients like Childs. Yet it also forces them into a trade-off: more pain for more time.

Childs, 56, a Jacksonville resident, is one of a handful of Florida women who took part in the study for the new treatment, which involves injecting chemotherapy drugs directly into the abdomen. The results, published this month in the New England Journal of Medicine, are being called the biggest advance against the disease in years.

For patients who have the right type of ovarian cancer, the new treatment has become the best chance to live. Ovarian cancer kills 16,000 women a year, but the treatment extended the median survival for patients by 16 months over those getting the drugs delivered via their bloodstream.

It isn't easy. The side effects are so difficult that many patients couldn't complete it. The same factors that make it more effective also make it more toxic.

"We're always weighing quality of life in the balance," said Dr. Robert Wenham, a principal investigator of the Gynecologic Oncology Group at Tampa's H. Lee Moffitt Cancer Center & Research Institute, one of about 40 national sites in the study.

"Toxicity vs. survival time - often how someone feels during treatment changes."

Sometimes, Wenham said, patients find the pain is more than they can take. Other times, the opposite happens: Patients start out deeply afraid, but find reserves of strength.

"I'm impressed every day by the resolve and tolerance of my patients," said Wenham, who's leading the study followup for Moffitt.

The day Childs was diagnosed, she heard the grim statistics. Because there is no easy test or early symptoms marking ovarian cancer, most patients aren't diagnosed until the cancer is advanced. About 44 percent survive five years after diagnosis, roughly half the rate of breast cancer survival.

Childs went home and cried all night long.

Then she decided God would take care of her. She had surgery within a week to remove "everything but my belly button."

She still needed chemotherapy to kill leftover cancer cells and had no doubts about participating in the study.

"If you introduce the drug to the direct source of the problem," she said, "it made common sense to me that you would have a better chance than waiting for it to travel through your bloodstream."

Childs was hospitalized for each treatment. First, over 24 hours, the drug Taxol would run through a port in her chest into her bloodstream. Then a second drug, cisplatin, would be injected into her abdomen.

"You're basically having the equivalent of a 2-liter Coke bottle injected," Childs said.

Unlike some patients, she didn't find that part especially painful. Toward the end of each injection, she felt uncomfortable and bloated. The worst part came later. After each treatment, she would throw up several times a day for four days straight. The nausea would finally start to subside on the fifth day.

She felt weak and exhausted as the chemicals killed her red blood cells, and she had to take another drug to fight the fatigue. Her hair fell out. She lost nearly 60 pounds.

She would start to feel better. Then came another round - six in all, spaced three weeks apart.

The problems that Childs and other patients experienced - tiredness, pain, nausea, numbness - affected patients getting only IV drugs as well. But the pain was worse for patients with abdominal treatment.

There are reasons for that, said Wenham and Dr. Richard Barakat, chief of gynecologic oncology at Memorial Sloan-Kettering Cancer Center in New York. Those getting abdominal drugs get more chemicals delivered directly to cancer cells.

"In a sense, you're sort of soaking the tumor with chemotherapy," Barakat said.

But with highly toxic cisplatin sitting in their abdomen, the rest of the body gets more exposure too. Even so, both doctors believe most of their patients will be willing to try the treatment.

"Sixteen months can be the difference in a woman seeing her children graduating from high school or not," Wenham said.

Barakat has already seen patients choosing the new treatment. Sloan-Kettering made abdominal treatments standard for this group of patients a year ago.

"Any cancer patient who's given a choice, the majority are going to want treatment that's more effective in exchange for toxicity," Barakat said.

In the study, 83 percent of patients getting IV drugs completed all six courses of treatment, while only 42 percent of the abdominal group did. But IV treatment is "no walk in the park" either, Barakat said.

Largo resident Sharon Biach, 66, knows that firsthand. She also participated in the study, getting traditional chemotherapy. After the first treatment, in 1999, her hair fell out, and she was surprised by how upset she was. After each round, her legs ached for days, and she struggled with nausea as well.

Biach became so sick after her last treatment she was hospitalized for dehydration.

Even so, it wasn't really as bad as she expected.

"I tell people there is so much hope today," she said. "Compared to 20 years ago, your chances are really good."

The next step for cancer researchers is to find ways to make the abdominal treatments less toxic, Wenham and Barakat said. The most common reason for women not to complete the abdominal treatment was because of complications from the abdominal catheter, which Barakat expects to become less common as doctors use them more often. Sloan-Kettering now has an 80 percent completion rate for patients getting abdominal chemo.

Wenham expects researchers to look at injecting a different drug, less toxic than cisplatin but also effective, into the abdomen instead.

Still, the new therapy isn't for everyone. The study specifically looked at women who had advanced cancer but were able to have surgery that removed all tumors larger than 1 centimeter.

For that group, the pain comes with hope.

For others, the benefit is less certain. The study didn't look at women whose cancer has returned.

"We're usually willing to tolerate a lot of toxicity when we're on the first round, because we're going for a cure," Wenham said. "But when it recurs and there's no chance of a cure, we want to pick treatments based on quality of life issues."

It was two months after the treatments ended that Childs noticed the numbness in her hands, legs and feet. By January, she couldn't pick up a pen. Treatment helped, and she is still able to work at the job she loves, as a sales representative for a building supply distributor.

The numbness has never gone away. Childs has a handicapped sticker for her car, and she can't walk far. But she doesn't let it stop her. She still travels often. These days, if she's changing planes, she calls the airline to ask for a wheelchair or shuttle.

She has no regrets. Childs is absolutely sure that without the chemotherapy, she would have died.

"I would do it again to save my life," Childs said. "Just because I can't wear high heels, it's a lot better than taking a dirt nap."

Instead, this weekend Childs and her friends are celebrating her 56th birthday.

[Last modified January 15, 2006, 10:23:17]