Bringing Specialized Cancer Care Closer to Home: Research Supports Expanding Access to CRS/HIPEC
Hickey, K., et al. (2025). Feasibility of a Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Program for Gastrointestinal and Gynecological Cancer Care in Newfoundland and Labrador. Onco, 5(2), 16. https://doi.org/10.3390/onco5020016
For patients diagnosed with advanced abdominal cancers, finding the right treatment can sometimes mean traveling far from home. Specialized procedures like cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are not available at every hospital, leaving some patients and families facing difficult decisions about travel, finances, and access to care.
A study published in Onco explores whether expanding access to these specialized treatments could help more patients receive care closer to home.
Understanding the Research
Researchers at Memorial University of Newfoundland examined whether the Canadian province of Newfoundland and Labrador had enough eligible patients to support a specialized CRS/HIPEC treatment program.
CRS and HIPEC are sometimes used together to treat certain advanced abdominal cancers that have spread to the peritoneum, the thin tissue lining the abdominal cavity and covering many of its organs.
Cytoreductive surgery (CRS) involves surgically removing visible cancer from the abdominal cavity.
Hyperthermic intraperitoneal chemotherapy (HIPEC) delivers heated chemotherapy directly into the abdomen during surgery to target cancer cells that may remain after tumor removal.
For carefully selected patients, these approaches may offer important treatment benefits. However, CRS/HIPEC is a complex procedure requiring experienced surgeons, specialized equipment, and a coordinated medical team.
At the time of the study, CRS/HIPEC was not available in Newfoundland and Labrador. Patients who needed the treatment had to be referred to specialized centers outside the province.
Researchers wanted to understand whether there were enough eligible patients locally to justify developing a program that could provide this care closer to home.
What Did the Study Find?
The researchers reviewed cancer registry records from January through December 2020, focusing on patients with advanced colorectal, appendix, stomach, and ovarian cancers.
They identified 31 patients who met the study's eligibility criteria for CRS/HIPEC during that one-year period.
Of these patients:
11 patients had gastrointestinal cancers, including colorectal, appendix, or stomach cancer.
20 patients had gynecologic cancers, specifically advanced epithelial ovarian cancer.
63% of the gastrointestinal patients were referred outside the province for CRS/HIPEC.
Patients with gynecologic cancers received treatment within the province, including cytoreductive surgery and systemic chemotherapy, sometimes with chemotherapy delivered directly into the abdomen.
The researchers concluded that the number of eligible patients was sufficient to support establishing a combined CRS/HIPEC program in Newfoundland and Labrador.
The Canadian HIPEC Collaborative Group recommends that centers perform at least one procedure per month to help maintain experience and quality of care. With 31 potentially eligible patients identified in one year, the researchers suggested that a local program could meet this patient-volume benchmark.
However, creating such a program would require substantial planning, including specialized training, equipment, treatment protocols, and collaboration among surgical and gynecologic oncology teams.
Why Does Access to Specialized Care Matter?
For patients facing advanced abdominal cancer, accessing specialized treatment can involve much more than finding the right physician.
Traveling to a distant cancer center may mean spending weeks away from home, arranging transportation and lodging, taking time away from work, and relying on family members or caregivers for additional support.
These challenges can create significant financial, emotional, and logistical burdens during an already difficult time.
This research highlights an important consideration: when there are enough eligible patients and appropriate resources, developing specialized treatment programs closer to home may help reduce some of these barriers.
At the same time, providing complex treatments locally requires more than equipment or sufficient patient numbers. Specialized expertise, multidisciplinary collaboration, and ongoing experience are essential to delivering safe, high-quality care.
What Does This Mean for Patients?
Although this study focused on one Canadian province, its findings raise broader questions about access to specialized abdominal cancer care.
For patients with cancers involving the peritoneum, understanding all potentially appropriate treatment options is important. This may include consulting a surgical oncologist with expertise in peritoneal surface malignancies and CRS/HIPEC.
Not every patient with advanced abdominal cancer is a candidate for these procedures. Treatment decisions depend on several factors, including the type of cancer, the extent of disease, previous treatments, and the patient's overall health.
Patients and caregivers may want to ask their healthcare team:
Has my cancer spread to the peritoneum?
Should I be evaluated by a specialist experienced in treating peritoneal surface malignancies?
Could CRS/HIPEC be appropriate for my diagnosis?
If specialized treatment is unavailable locally, can I receive a referral to an experienced center?
What support resources are available if I need to travel for treatment?
The Alliance's Takeaway: Specialized Care Should Be Within Reach
At the Abdominal Cancers Alliance, we believe patients deserve access to information, experienced specialists, and the opportunity to explore appropriate treatment options, regardless of where they live.
This research reinforces an important part of that mission: improving access to specialized care requires awareness, collaboration, and thoughtful development of treatment programs.
The study did not evaluate whether establishing a new program would improve survival or other patient outcomes. Rather, it demonstrated a potential need and sufficient patient volume to support further development of specialized services.
For patients, the message is clear: knowing when to seek a specialized opinion can be an important step in understanding your treatment options.
Whether that expertise is available close to home or requires travel, patients and families should be empowered to ask questions, seek second opinions, and find experienced medical teams.
The Abdominal Cancers Alliance is committed to helping patients and caregivers navigate these decisions and connect with resources and specialized care.
