Last year an interesting article appeared in the Economist that addressed the issue of what is unbearable, or what is a fate worse than death. The article written by Dr. Rubin in JAMA Internal Medicine addressed the issue of how chronically ill patients viewed symptoms that were potentially worse than death. Surprisingly, at least to me, was that the number 1 worse than death condition was bladder and or fecal incontinence.
In 2014, over 200,000 patients received abdominal or pelvic radiotherapy as part of their treatment protocol. Having survived the cancer, they are now facing chronic gastrointestinal issues, which rarely get better and more often than not, get worse. After pelvic radiation, almost ALL patients experience permanent change in their bowel function. Over 50% of patients who have had pelvic radiation will have some symptoms of fecal or urinary urgency, incontinence and pain as a long term complication and over 30% will have moderate to severe symptoms that significantly impact their quality of life.
Let us look at women who have had pelvic radiotherapy for gynecologic cancers. Upwards of 25% will have severe urgency, frequency and incontinence after radiotherapy for their cervical cancer. Vaginal necrosis has implications beyond sexual dysfunction, as just having urine go by that area multiple times per day must be excruciatingly painful. A recent review article from Brigham and Women’s Hospital/Dana-Farber Cancer Institute recommended hyperbaric oxygen as a possible treatment option for this devastating complication of their cancer therapy.
Many clinicians are unaware of the long-term psychological impact of pelvic radiation disease (PRD). Because there is a long time between therapy and presentation of PRD, it is likely that a patient is not followed by the same specialty for the remainder of their lives. If you are having problems with rectal bleeding, you are likely to be seen by a gastroenterologist, who may not be as familiar as a gynecologic oncologist about the long-term manifestations of the curative radiotherapy. The GI doctor is less likely to attribute these problems to the radiation, and may be more likely to treat the symptoms than search for a potential “fix” for the problem. Studies have shown that even after 2 years, patients who have survived cervical cancer have a reduced quality of life, are unable to perform normal activities of daily life such as housekeeping, and are less able to plan for the future. 
The underlying problem is that while radiation helps to cure cancer, it also affects the surrounding normal tissue. This delayed effect or chronic radiation tissue damage to normal tissues is manifested in increased fibrosis, a decrease in the capillary network (reducing blood supply to the area), a depletion of stem cells, and an increase in tissue hypoxia. This is manifested clinically by urgency, incontinence, pain and bleeding.
That all sounds fairly benign, after all you have survived CANCER, but when you look at it on a more granular level, it starts to sound horrible. You can’t get up to go to the bathroom when you are on a flight, therefore your travel is severely limited. You have no way of controlling accidental leakage, so you wear a diaper everyday. No more beach holidays for you. You have to go urgently.
But we can fix this!!!
Hyperbaric oxygen therapy (HBOT) can reverse the delayed effects of radiation on normal tissue by reducing fibrosis, increasing capillary density in the irradiated field, increasing stem cell release, and increasing the level of oxygen that is being provided to the tissues. HBOT has been shown to improve quality of life parameters in these patients as well as reduce the symptoms Clinical algorithms are recommending HBOT as a recommended medical therapy if sucralfate enemas (Carafate) and oral metronidazole (Flagyl) do not work.
If you are suffering after successful cancer therapy, consider asking your provider to refer you for hyperbaric oxygen therapy. It is almost universally covered by insurance plans, both commercial and Medicare/Medicaid. You can do this, and make your life better, and throw away your “Just Can’t Wait” card.
Call Hyperbaric Physicians of Georgia for your consultation with our experts or fill out a form, we are here to help you get back to your life.
1. The Economist “What is unbearable?” The Economist Group Limited., August 6, 2016
2. Rubin EB, Buehler AE, Halpern SD. States Worse Than Death Among Hospitalized Patients With Serious Illnesses. JAMA Intern Med. 2016;176(10):1557–1559.
3. American Cancer Society. Cancer Facts and Figures 2014. Atlanta, GA: American Cancer Society; 2014.
4. Andreyev, H. J. N. “Pelvic radiation disease.” Colorectal disease 17.1 (2015): 2-6.
5. Viswanathan, Akila N., et al. “Complications of pelvic radiation in patients treated for gynecologic malignancies.” Cancer 120.24 (2014): 3870-3883.
6. Klee M, Thranov I, Machin D. Life after radiotherapy: the psychological and social effects experienced by women treated for advanced stages of cervical cancer. Gynecol Oncol. 2000;76:5–13
7. Clarke RE, et al. Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow-up. Int J Radiat Oncol Biol Phys. 2008;72:134–143
8. Management of Intestinal Complications in Patients With Pelvic Radiation Disease. Clinical Gastroenterology and Hepatology Volume 10, Issue 12, December 2012, Pages 1326–1334.e4