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Hot Chemotherapy Bath offers controversial hope to peritoneal mesothelioma sufferers

04 November 2014

Doctors Operation by David Castillo Dominici

The vast majority of asbestos-related mesothelioma cases occur in and around the lungs but in rare cases mesothelioma can occur in the abdomen. This is known as peritoneal mesothelioma.

The peritoneal is a membrane that covers the liver, intestines, and other organs of the abdomen. The cancer can occur either on the membrane of the abdomen or across the organs themselves.

Peritoneal mesothelioma does not cause symptoms until the disease is well advanced and the tumour is very fast growing, which means the outcome following diagnosis can be rapid and deadly. Faced with such a bleak prognosis, we know that sufferers have turned to radical and extreme cancer treatments that are not always clearly proven to work.

One such cutting-edge treatment that has gathered considerable attention over the past five years is the ‘hot chemo bath’. The treatment is also called cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy, or Hipec.

The procedure involves hours of surgery to remove visible tumours (debulking) from within the abdomen. The surgery is then followed up by the abdominal cavity being flushed through with a hot chemotherapy bath.

The treatment is aggressive, invasive and painful. Only two NHS hospitals perform the procedure but the number of treatments is increasing, commonly for appendix, colorectal or ovarian cancers. In the past six years The Christie, in Manchester, has performed 264 cytoreductive surgeries with Hipec.

To critics there is little evidence to support that it really works but to some patients, this gruelling and invasive procedure, represents their best hope for survival. Proponents say that lives can be prolonged by removing all the visible tumour and killing what is missed with Hipec.

America has pioneered the procedure but the debate is still raging there too. However, uncertainty has not stopped some of the country’s leading medical centres from offering the procedure and advocates predicted that the number of treatments could grow to 10,000 a year from about 1,500 in 2011. The therapy has even been featured on an episode of the TV series ‘Grey’s Anatomy’.

An excellent New York Times article summed up the debate and available research in 2011, and graphically details what such a treatment involves for the patient, referring to the procedure as ‘shake and bake’.

Back here in the UK the National Institute for Health and Care Excellence (NICE), which produces guidance (advice) for the NHS about preventing, diagnosing and treating different medical conditions, says:

“Current evidence on the efficacy of cytoreduction surgery (CRS) followed by hyperthermic intraoperative peritoneal chemotherapy (HIPEC) for peritoneal carcinomatosis shows some improvement in survival for selected patients with colorectal metastases, but evidence is limited for other types of cancer. The evidence on safety shows significant risks of morbidity and mortality which need to be balanced against the perceived benefit for each patient. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.”

NICE has produced information on the controversial procedure for patients and carers. It explains the nature of the procedure and the guidance issued by NICE, and has been written with patient consent in mind. You can find it here.

The guidance does not cover whether or not the NHS should fund the procedure. Decisions about funding are taken by local NHS bodies after considering how well the procedure works and whether it represents value for money for the NHS. In April of last year NHS England issued a clinical commissioning policy for the cytoreductive surgery and Hipec but peritoneal mesothelioma was not included in the scope for the policy, and it is likely asbestos victims would have to fund the procedure privately.

(Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net)

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