Practice patterns, attitudes, and knowledge among clinicians regarding hyperthermic intraperitoneal chemotherapy and pressurized intraperitoneal aerosol chemotherapy: a national survey by Indian society of peritoneal surface malignancies (ISPSM)

Abstract

ObjectivesPerception of cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) for treating peritoneal surface malignancies (PSM) differ widely among physicians.MethodsThis on-site survey performed during a major oncology congress in 2019 evaluated the current opinion, perceptions, knowledge and practice of HIPEC and PIPAC among oncologists in India.ResultsThere were 147 respondents (gynecologists (30%), surgical oncologists and gastrointestinal surgeons (64%), and medical oncologists (6%)). Whereas most respondents considered CRS and HIPEC an appropriate therapeutic option, 25% would not recommend CRS and HIPEC. The main barriers to referral to an expert center were inaccessibility to such a center (37.8%), non-inclusion of CRS and HIPEC in clinical practice guidelines (32.4%), and a high morbidity/mortality (21.6%). Variations were found in the various practice patterns of CRS/HIPEC like eligibility criteria, HIPEC protocols and safety measures. Although PIPAC awareness as a novel therapeutic option was high, only a limited number of centers offered PIPAC, mainly because of non-access to technology and missing training opportunities (76.2%).ConclusionsLack of widespread acceptance, poor accessibility and low utilization presents a significant challenge for HIPEC and PIPAC in India. There is a need to raise the awareness of curative and palliative therapeutic options for PSM. This might be achieved by the creation of expert centers, specialized training curricula and of a new sub-speciality in oncology.

Building an Efficient Peritoneal Surface Malignancies Program Despite the Lower-Middle–Income Barriers: Ukraine Experience

“…1,42,44,53 Here, patient-advocating nongovernmental organizations (NGOs) play a role in facilitating physician-patient interaction, providing educational content, psychological support, and even financial assistance for transportation, thereby addressing the PSM center inaccessibility barrier. 41,43,[54][55][56] Launching new CRS/HIPEC programs is another recommended yet resource-intensive way to deal with low access: initial significant caseloads at the Odesa and Kyiv centers showcase how unmet the demand was in these regions serviced before solely by the center in Lviv (Fig 1). 41 Any PSM program foundation rests on the surgeons training, which these programs typically start with.…”

“…Addressing misconceptions about CRS/HIPEC safety and efficacy is equally important. 43,50 Besides networking with PSM surgeons, referring physicians might alleviate their concerns with a national CRS/HIPEC registry publishing transparent outcomes of PSM centers. 41,44,51 As patients and their families often independently seek new treatments, their awareness is also crucial.…”

Should We Abandon Intraperitoneal Chemotherapy in the Treatment of Advanced Ovarian Cancer? A Meta-Analysis

“…Moreover, the low utilisation of intraperitoneal chemotherapy is due to catheter-related complications such as obstruction or abdominal pain during treatment. These complications and the lack of training of oncologists in their management mean that a large part of the medical oncology community is reluctant to use intraperitoneal chemotherapy in patients with advanced ovarian cancer despite the scientific evidence and the recommendations of clinical guidelines [54].…”

Enhanced recovery after surgery in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: national survey of peri-operative practice by Indian society of peritoneal surface malignancies

“…Enhanced recovery after surgery (ERAS) protocols represent fundamental shifts in surgical practice designed to achieve early recovery by maintaining preoperative organ function and reducing the profound stress response following surgery [ 2 ], [ 3 ], [ 4 ]. A survey showed CRS and HIPEC has been well accepted by the oncological community [ 5 ].…”

“…ERAS programs offer a practical, evidence based, patient-centric practices to eliminate ambiguities, disparities to achieve best surgical care. There is already significant evidence indicating that ERAS protocols leads to improved outcomes in major abdominal and extra-abdominal surgical procedures, while being safe [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ].…”