ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Thursday, May 23, 1996 TAG: 9605230059
SECTION: NATIONAL/INTERNATIONAL PAGE: A-14 EDITION: METRO
DATELINE: PHILADELPHIA
SOURCE: PHILADELPHIA INQUIRER
Most women with highly curable, early-stage ovarian cancer are not meticulously checked during surgery to see if the disease has spread - a lapse that could increase their chances of dying, according to a new National Cancer Institute study.
The study also found that women frequently are not given the state-of-the-art chemotherapy treatments recommended for ovarian cancer, especially if they are 65 or older and have advanced disease.
``It certainly is disturbing that people aren't getting the treatment we recommend,'' said Dr. Edward Trimble, an NCI researcher who presented the findings Tuesday at the annual meeting of the American Society of Clinical Oncology in Philadelphia.
``People who receive suboptimal care are not going to have survival as good as people who have optimal care,'' he said.
Ovarian cancer kills about 15,000 women annually in the United States. It has an 85 percent to 90 percent cure rate if it is caught while confined to the ovaries. But because early symptoms are vague, three-quarters of all cases are not detected until the cancer is more advanced and more lethal.
According to 1994 NCI guidelines, surgeons operating on women with early-stage disease should not simply remove the cancerous ovary. Even if there are no visible signs the cancer has spread, the surgeons should take samples of lymph nodes and other sites around the abdomen and pelvis to check for microscopic disease. If the cancer has spread, chemotherapy is needed.
In the study, NCI researchers reviewed the cases of 785 women diagnosed with ovarian cancer in 1991. They found that 90 percent of those with early-stage cancer did not get optimal treatment - most typically their surgeon failed to sample lymph nodes for signs of cancer.
Among women with advanced ovarian cancer, 80 percent received the appropriate surgery and follow-up chemotherapy, the study found. But among those women 65 or older with advanced disease, only 43 percent received state-of-the-art care.
Trimble said the fact that older women are not being given top-notch treatment could reflect an attitude that little can be done for them and they will die soon anyway.
``Families and physicians may not appreciate the fact that many older women can safely undergo the appropriate surgery and safely get the appropriate chemotherapy,'' Trimble said.
The study will continue to follow the women to see whether those who got good care for their ovarian cancer were more likely to survive at least five years. Such data will not be available until 1997.
The study did not take into consideration what type of surgeon did the operation. But it did find that women who were treated in teaching hospitals with approved residency training programs received better care than those in nonteaching hospitals.
Dr. Patricia Braly, of Louisiana State University Medical Center, said one reason for substandard treatment of early-stage cancers may be that they are often discovered accidentally, during surgery for unrelated problems. This makes timely planning and decisions about treatment more difficult.
Robert Ozols, a medical oncologist at Fox Chase Cancer Center in Philadelphia, said many women with ovarian cancer are treated by doctors without expertise in the disease. He recommends that women with a suspicion of ovarian cancer get their surgery from a gynecological oncologist. The NCI guidelines make a similar recommendation, if there is a ``high probability'' of cancer.
Trimble said a study published in 1993 found that women with ovarian cancer had a better chance of survival if they were operated on by a gynecological oncologist rather than by a regular gynecologist or general surgeon. The difference wasn't necessarily one of surgical skill, he said, but rather in the understanding of the disease.
Patients should ask if someone specially trained in the care of ovarian cancer will be available for consultation the day of surgery.
Trimble said patients should also specifically ask whether the surgeon will sample lymph nodes and other sites for analysis for cancer during the surgery. After surgery, the patient needs to have a thorough discussion of whether chemotherapy is warranted and then go for a second opinion, he said.
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