The impact of hyperbaric oxygen therapy on late radiation toxicity and quality of life in breast cancer patients

Marilot C T Batenburg,Wies Maarse,Helena M Verkooijen,Inge O Baas,Femke Van Der Leij,Desiree H J G Van Den Bongard,Annemiek Doeksen,Onno Boonstra,Nina Lansdorp

doi:10.1007/s10549-021-06332-2

Abstract

PurposeTo evaluate symptoms of late radiation toxicity, side effects, and quality of life in breast cancer patients treated with hyperbaric oxygen therapy (HBOT).MethodsFor this cohort study breast cancer patients treated with HBOT in 5 Dutch facilities were eligible for inclusion. Breast cancer patients with late radiation toxicity treated with ≥ 20 HBOT sessions from 2015 to 2019 were included. Breast and arm symptoms, pain, and quality of life were assessed by means of the EORTC QLQ-C30 and -BR23 before, immediately after, and 3 months after HBOT on a scale of 0–100. Determinants associated with persistent breast pain after HBOT were assessed.Results1005/1280 patients were included for analysis. Pain scores decreased significantly from 43.4 before HBOT to 29.7 after 3 months (p < 0.001). Breast symptoms decreased significantly from 44.6 at baseline to 28.9 at 3 months follow-up (p < 0.001) and arm symptoms decreased significantly from 38.2 at baseline to 27.4 at 3 months follow-up (p < 0.001). All quality of life domains improved at the end of HBOT and after 3 months follow-up in comparison to baseline scores. Most prevalent side effects of HBOT were myopia (any grade, n = 576, 57.3%) and mild barotrauma (n = 179, 17.8%). Moderate/severe side effects were reported in 3.2% (n = 32) of the patients. Active smoking during HBOT and shorter time (i.e., median 17.5 vs. 22.0 months) since radiotherapy were associated with persistent breast pain after HBOT.ConclusionBreast cancer patients with late radiation toxicity reported reduced pain, breast and arm symptoms, and improved quality of life following treatment with HBOT.

Highlights

Around 68% of all women with breast cancer undergo radiotherapy as part of their treatment [1]
Treatment of late radiation toxicity depends on the symptoms and may consist of analgesics, physiotherapy, lymphedema therapy, and in some cases surgery
In the Netherlands, hyperbaric oxygen therapy (HBOT) is mostly used as a treatment option for late radiation toxicity in breast cancer patients who insufficiently benefited from analgesics, physiotherapy, or lymphedema therapy

Summary

Introduction

Around 68% of all women with breast cancer undergo radiotherapy as part of their treatment [1]. Breast Cancer Research and Treatment (2021) 189:425–433 Symptoms such as fibrosis and breast pain may continue to increase during at least 10 years after radiotherapy and substantially impair daily functioning and quality of life [5]. Treatment of late radiation toxicity depends on the symptoms and may consist of analgesics, physiotherapy, lymphedema therapy, and in some cases (reconstructive) surgery. Another proposed treatment for late radiation toxicity is hyperbaric oxygen therapy (HBOT). Evidence for the effectivity of HBOT in breast cancer patients with late radiation toxicity is limited [11, 12]. In the Netherlands, HBOT is mostly used as a treatment option for late radiation toxicity in breast cancer patients who insufficiently benefited from analgesics, physiotherapy, or lymphedema therapy

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Results

Conclusion