Many stomach cancer patients are not receiving best treatment

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A significant number of U.S. patients nationwide are not getting the recommended therapy after surgery to remove stomach cancer, according to new findings from Oregon Health & Science University Cancer Institute in Portland, Ore., presented at the 2008 American Society of Clinical Oncology (ASCO) meeting in Chicago this week.

“We were surprised to learn that there are still many patients who are not receiving the gold standard of chemotherapy and radiation after surgery - despite compelling clinical data available since 2001. However, it is encouraging to see there has been a significant increase in the use of chemo-radiotherapy since it became the standard of care,” said Kristian Enestvedt, MD, principal investigator, department of surgery at the OHSU School of Medicine.

A 2001 seminal study showed that using chemotherapy and radiation, also called chemo-radiotherapy, after gastric cancer surgery increased survival. Other studies have also recommended that at least 15 lymph nodes should be removed with gastric resection surgery.

However, OSHU researchers noted that the little data has existed until now about whether this recommended practice was being followed.

For the current study, the researchers examined 313 patient cases from a statewide cancer registry. The chemo-radiation therapy was used only 14.2 percent of the time before 2001 and 33.3 percent after that date, according to the investigators.

“That still leaves almost 67 percent of cases left in which patients did not get the appropriate - and potentially life-extending - therapy. We found that there was a five-month survival advantage for patients who received chemo-radiotherapy,” Enestvedt said. 

Also, researchers found that only 35 percent of patients had at least 15 nodes removed to check for cancer. The number of lymph nodes removed, however, did not affect survival, according to Enestvedt and colleagues.

"What patients should know is that they should routinely ask their physicians if their treatment plan includes the latest clinical trial data that pertains to their particular situation," said Charles Thomas, MD, co-author, chairman and professor of radiation medicine, OHSU School of Medicine, OHSU Cancer Institute member.

One million people die of stomach cancer worldwide each year.

Other researchers involved include: Kevin Billingsley, MD, head of surgical oncology, Hedinger associate professor of surgery, OHSU School of Medicine, OHSU Cancer Institute; Brian Diggs, PhD, senior research associate of surgery (general surgery) at OHSU; and Donald K. Shipley, MS, manager at Oregon State Cancer Registry.