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This information is about the use of hyperbaric oxygen therapy (HBO) for people with cancer. HBO therapy is sometimes used to treat a number of severe side effects of treatment for cancer.
Hyperbaric oxygen therapy is a form of treatment which involves providing the body with extra oxygen. 'Hyper' means increased and 'baric' relates to pressure. Oxygen (O2) is one of the gases in the air that we breathe, and is essential for life. Normally, oxygen makes up just over one fifth (21%) of the air that we breathe.
In HBO therapy, pure oxygen is given to patients in chambers known as hyperbaric oxygen chambers. People can breathe this increased oxygen by sitting in the chamber and using a mask or hood.
Hyperbaric chambers first came into use in the 1880s and are used to treat some acute illnesses such as decompression sickness (the 'bends') in divers, carbon monoxide poisoning and air embolism.
HBO therapy can help in a number of different situations where body tissues have suffered from a decrease in oxygen levels. These include:
Oxygen is carried around the body by the blood. Breathing in 100% (pure) oxygen under increased pressure (HBO) allows extra oxygen to be taken up by the blood stream and dissolved at a far greater rate than if pressure was not used. This extra oxygen can help where healing is slowed down by infection or where blood supply is limited by damage to the tissues. HBO therapy:
Radiotherapy| treatment for cancer can cause changes in the oxygen supply to tissues in the treated area. This is because radiotherapy affects normal cells and blood vessels as well as cancer cells.
The small blood vessels in the treated area can be damaged by radiotherapy treatment, causing less blood to be supplied to that area. When this happens, it becomes more difficult for essential oxygen and nutrients to reach the tissues. Over a period of time, these affected tissues may start to break down and become fragile. The tissues may form areas of open sores (ulceration) and, rarely, some tissues may eventually die off completely (radiation necrosis). These radiation injuries can occur very slowly over a number of months or even years.
Although HBO treatment has been available for a long time, its use for these effects of cancer is relatively new. Research into the use of HBO in treating the long-term side effects of radiotherapy is ongoing in the UK. However, previous studies have suggested that HBO may be effective in the following conditions:
Radiotherapy is often given after breast-conserving surgery for breast cancer|. A potential side effect of radiotherapy to the breast and armpit is lymphoedema| (especially if all the lymph nodes have been surgically removed).
Lymphoedema is a swelling in the arm because of an abnormal collection of lymph in the body’s tissues. It can cause pain and redness (erythema). HBO therapy may help these symptoms by reducing the swelling in patients where the tissues are not too badly damaged. Research trials are looking at how effective HBO therapy is in treating lymphoedema.
HBO therapy may help these symptoms by reducing the swelling in the area in those patients where the tissues are not too badly damaged. Research trials| are looking at how effective HBO therapy is in treating lymphoedema.
Radiotherapy is used as a treatment for some types of pelvic cancer. Sometimes treatment can lead to chronic cystitis (inflammation of the bladder tissues). Symptoms include increased urinary frequency (needing to go a lot), pain when passing urine, and blood in the urine (haematuria). These problems can occur months or years after treatment. Symptoms can be persistent and range from moderate to severe. HBO therapy may be useful to relieve these symptoms when other forms of treatment have been tried without success.
Radiotherapy is often used for cancers in the head and neck. The tissues around this area are fragile and may break down after radiotherapy, particularly if surgery has been carried out previously. Although it is rare, the bone itself can be affected by radiotherapy and start to break down and die. This is known as osteoradionecrosis. It can also happen when radiotherapy is given to other areas of the body, such as the chest or the pelvis.
A research study called HOPON is finding out if giving HBO prevents damage to your jaw bone after radiotherapy for head and neck cancer.
Treatment for osteoradionecrosis includes antibiotics, ‘washing-out’ the area with salty water (saline irrigation), and sometimes surgery to remove some or all of the affected bone. Although HBO therapy cannot restore the dead bone, increased oxygen can help the tissues around the area to heal by encouraging blood vessels to grow.
HBO therapy can also be given before reconstructive surgery to help the healing process, prevent infection and encourage blood vessels to grow and form new bone. If wounds or tissue are infected, treatment would usually consist of medicines or surgery as well as HBO therapy.
Having a tooth removed shortly before, during or after radiotherapy treatment to the mouth and jaw area may increase the risk of osteoradionecrosis. This is because of the reduced oxygen supply to the area. HBO therapy can be given to help prevent this happening (if used both before and after the tooth extraction) and to stimulate the healing process.
Radiotherapy can be given for pelvic and bowel cancer. The rectum is very sensitive and, although rare, long-term symptoms due to radiation damage can occur. These include pain, bleeding and irregularity in bowel habits. If these symptoms do not improve following treatments such as anti-inflammatory medicines, HBO therapy may be helpful.
A new research study called HOT II is trying to find out if HBO helps people who have developed bowel complications as a result of radiotherapy to the pelvis.
Your doctor can refer you for HBO therapy if you have long-term side effects of radiotherapy that have not responded to normal treatment. Your consultant can advise you whether HBO therapy is appropriate in your situation.
HBO therapy is not always offered as a routine treatment for radiation damage, as it is a fairly new treatment in cancer care and knowledge about the potential benefits is not widespread. You can be referred for treatment by your GP or hospital specialist. Treatment is only offered at specialised hyperbaric centres throughout the UK, so you may have to travel some distance.
Before having HBO therapy you will be examined by a doctor to make sure that you are fit enough to receive this type of treatment. HBO therapy is suitable for most people. It is given inside a chamber, so if you have a fear of enclosed spaces (claustrophobia), you may need medicines to help overcome any anxiety.
If you smoke, you will be asked to stop smoking before and during treatment as this is likely to affect the level of oxygen in your body.
Treatment is usually painless and is carried out in simple chambers. There are two types of chamber: a monoplace chamber and a multiplace chamber.
A monoplace chamber is designed to treat one person at a time and involves lying on a 2.1m (7ft) padded stretcher that slides into a clear plastic tube (chamber) about 60cm (2ft) wide. Once you are inside, the door is closed and the chamber is pressurised. You will be able to see and talk to a member of staff at all times during the treatment.
Multiplace chambers are designed to hold and treat several people at a time (up to 12), and are more commonly used. These chambers are quite large and you will be able to walk about inside. Once you are sitting or lying inside the chamber, the doors will be closed and air is blown into the chamber to increase the pressure. You will hear a sound similar to that in an aircraft as the air begins to circulate.
In both monoplace and multiplace chambers it is necessary to 'clear' your ears as soon as the pressure begins to increase. You will be shown how to do this. Clearing your ears helps to equalise the pressure in your ears and prevent any pain in your eardrum.
When the pressure reaches the correct level, you will be asked to put on either a mask or a clear hood to receive 100% oxygen. Monoplace chambers are pressurised using 100% oxygen, so it is unnecessary to wear a mask or hood. You will be able to relax, read, or listen to music and you can talk to staff who are operating the chamber should you need anything.
Near the end of the treatment the pressure in the chamber is slowly decreased. You may feel 'popping' in your ears during this time. After the decompression phase you can leave the chamber.
The length of each treatment varies depending on what you are being treated for and can last anywhere from 60–90 minutes at a time. Treatments are usually repeated over a number of days, or several weeks. The entire course should be completed for maximum benefit.
Treatment sessions are likely to be postponed if you are suffering from a severe cold or flu, runny nose, vomiting or are generally feeling unwell. You should let your nurse or doctor know if you have any of these symptoms before starting a treatment session.
HBO therapy is an extremely safe treatment with few side effects, which are usually minor and short lived. We have outlined the most common and less common side effects so that you can be aware of them. If you notice any other problems which you think may be due to the treatment, please discuss them with your nurse or doctor.
Blurred vision This can occur after having multiple treatments and is due to the development of short sightedness (myopia). The effect usually comes on gradually and then gets better slowly when treatment ends. Temporary use of glasses or a change in prescription may be helpful, but the blurred vision only lasts a few weeks at most.
Light-headedness Some people feel light-headed after treatment. This only lasts for a few minutes.
Fatigue Tiredness| is a side effect which can be more of a problem if you have treatment more than once a day. The effect usually wears off after a few days once the treatment sessions are finished.
Ear problems Although rare, damage to the eardrum can occur due to the change in pressure. Before treatment you will be shown how to equalise the pressure in your ears, which can help to prevent any ear problems.
Sinuses The change in pressure may cause discomfort if you have congested sinuses, leading to headaches or facial pain. Usually this can be controlled with decongestant medicine, but occasionally HBO therapy needs to be stopped.
This section has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography|.
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