Receiving a stage IV ovarian cancer diagnosis, the terminal stage of ovarian cancer, can be shocking and overwhelming. This is what happened to 77-year-old Isabel Navas. She first started to experience a bloated stomach, but never considered the possibility that she could have cancer because she did not experience any pain. Navas underwent a total hysterectomy and she was started on chemotherapy; however, within two weeks, her doctors informed her that the cancer had spread. “Your world comes crashing down within a second,” said Marcos Navas, Isabel’s son.
What is a chemo bath?
At this point, Navas turned to Dr. Sharyn Lewin and Dr. Steve Kwon, gynecologists who are a part of the gynecological oncology team at Holy Name Medical Center. They decided to try out an experimental procedure known as a ‘chemo bath’. “It involves two components. One is surgery where you have to remove all the visible cancer. The second part is the installation of a high temperature chemotherapy into the abdominal wall cavity,” said Dr. Kwon. The entire procedure takes around 8-10 hours.
Navas’s stomach was filled with chemotherapy liquid heated to 108 degrees Fahrenheit. Research findings suggest that since cancerous cells cannot tolerate heat, pouring hot chemotherapy liquid can help to terminate the cancerous cells, without affecting the healthy ones. Once the chemotherapy is administered, surgeons tend to shake the abdomen to ensure that the hot liquid encompasses all of the tumor cells. This is why the process is sometimes called ‘shake and bake’.
Hyperthermic intraperitoneal chemotherapy (HIPEC), commonly known as ‘chemo bath’, is typically used to treat individuals with a wide range of abdominal and gastrointestinal cancers. “All of these patients are now cancer free, which is so wonderful,” Dr. Lewin said. Isabel is merely one of the individuals whose battle with ovarian cancer turned into a triumph. Her quick recovery earned her the nickname “the miracle lady”, which her doctors praise to be based on her positive outlook and the tremendous support she received from her family.
Chemo bath treatments have proven successful
Yet, Isabel’s story is not the first one to show how the hope of an experimental procedure turned into a life-saving treatment. Another woman, by the name of Dawn Green, was diagnosed with cancer in January of 2008 and she was told that she had 12 weeks to live. She was not given a name for the cancer so she desperately turned to the internet for answers. Her search led her to discovering that she had a cancer known as pseudomyxoma peritonei (PMP). This rare type of cancer begins in the appendix and usually spreads into the abdominal cavity. Since the cancer presents common symptoms, such as a bloated stomach and stomach pain, it is often misdiagnosed or remains invisible until it has spread to other areas of the body. Moreover, Green’s search showed her that there was a treatment option available to her at two NHS hospitals – Basingstoke North Hampshire Hospital and the Christie Hospital in Manchester. She was referred to Basingstoke North Hampshire Hospital, where she sat down to talk with a consultant. “The consultant said my chances were only 50/50 but, after being told death was inevitable, those odds sounded fantastic,” she said. In June of 2008, Green underwent a chemo bath treatment. “I had heated chemotherapy inside me and for the next 23 hours, I was rotated in bed by the nursing staff to make sure the chemotherapy got to all parts of the abdomen,” she said. “Then it was drained and a fresh batch put in for another 23 hours. The heat was not a nice feeling but I was drugged up, and the doctors were monitoring me all the time, so I felt I was in good hands,” she added.
Dr. Sarah O’Dwyer, an experienced consultant surgeon at The Christie Hospital, stated that given at the right temperature, 108 degrees Fahrenheit or 42 degrees Celsius, chemo bath treatment does not affect the surrounding healthy cells. However, a higher temperature would heat up the body and cause the heart to stop. “But because the tissue lining the abdominal organs acts as a barrier to absorption of the drug, it can reach a high concentration in the tummy where the tumors are without reaching the blood stream and causing damage to other tissues,” she said. Green is one of numerous cancer patients whose case was considered terminal and yet, following a chemo bath, she was able to lead a decent quality of life even several years later. “I have recently found out that the cancer has returned, and am now considering my treatment options, but the chemo bath has given me the chance to see my girls, who are now 14 and 15, grow up and to spend time with them” she said.
Improving certain ovarian cancer survival by over 10%
Most recently, a new study published in the New England Journal of Medicine shows that chemo bath treatment improves survival among women diagnosed with stage III epithelial ovarian cancer by over 10%. A larger percentage of these women are treated with systemic chemotherapy and cytoreductive surgery and only around 30% make it through the 5-year survival rate. For this reason, researchers in the Netherlands aimed to determine whether a chemo bath could help to improve clinical outcomes among women with advanced epithelial ovarian cancer. They analyzed 245 patients, all of whom underwent interval debulking surgery with or without HIPEC treatment with cisplatin. The researchers found that patients who underwent HIPEC treatment experienced longer recurrence-free survival, in comparison to those who did not. What’s more, they found that patients who underwent HIPEC treatment experienced overall survival, in comparison to those who did not. The research team is currently in the process of altering their study’s regulations and guidelines. “Once the literature search supports the result of the trial we will want to implement it as standard of care. It will be difficult to repeat this trial with this number of patients and the results are convincing,” said Willemien J. van Driel, lead author of the study.
While thousands of patients can benefit from the chemo bath treatment, a majority of healthcare professionals are not aware of the treatment’s effects and therefore, it is not typically recommended. Most patients are currently offered palliative care, but chemo bath treatment can give them a few additional years for a decent life. “Our study of 30 bowel cancer patients — where the disease had spread to the stomach — shows that with chemo bath, 63 per cent were alive after three years. Among those treated palliatively, all died within 12 months. It is a massive difference,” said Dr. O’Dwyer. Despite the treatment’s severity, no patients have passed away while undergoing chemo bath treatment. However, the invasive procedure carries with it significant risks, including complications such as infections and organ failure. To date, 1% of patients have passed away from such complications.
Several researchers and healthcare professionals question whether pouring hot chemotherapy liquid straight into the abdominal activity is the ideal approach to treating cancer, as it can be painful and cause scarring. Yet, all agree that more research needs to be conducted on whether chemo bath treatment is helpful or misguided. In the meantime, awareness should be raised and hopefully in the near future, this procedure can be improved with safer and more effective measures.