Hyperbaric Oxygen Therapy in cancer treatment
Hyperbaric Oxygen Therapy HBO or HBOT (HBO2T) has its fans as an aid in Cancer Treatment. The argument runs that using a Hyperbaric Chamber (which is designed to increase blood oxygen levels and is proven to work in this way with a number of illnesses), will overcome one of the main influences of cancer: Namely, that cancer exists in a low-oxygen environment and plentiful oxygen can kill it off. HBOT has also been shown to significantly reduce inflammation in the body and this can be a precursor to cancer. Thus it has the potential to be a simple ´alternative cancer treatment´.
But. And it is a big BUT. Is there any evidence that this theory really could really translate into an alternative cancer ´cure´? Is there any evidence that it might be a very promising complementary cancer therapy?
The bottom line
1. Research shows it is already used to good effect when used with radiotherapy where it does seem to reduce tissue damage and side-effects.
2. Some cancer centres use it to improve the uptake of chemotherapy drugs and improve results.
3 On its own, in research with mice models, Hyperbaric Oxygen did NOT seem to offer any benefit in the fight against cancer.
4. However, when used in combination with a Ketogenic Diet, albeit in mice models, the benefits were significant.
5. And, research has shown that Hyperbaric Oxygen Therapy can not only increase the level of oxygen in the body´s healthy and radiation damaged tissue but HBOT will increase the oxygen levels in cancer tumours (Brizel DM et al; The mechanisms by which oxygen and carbogen improve tumour oxygenation - Br J Cancer 1995; 72; 1120-1124)
Here we look at the use of Hyperbaric Oxygen and cancer in a little more detail.
What is Hyperbaric Oxygen Treatment?
HBOT chambers to treat deep sea divers suffering from decompression sickness (the bends) were first developed by the military in the 1940s. Pilots who climb or lose altitude too quickly and miners who surface too quickly may also experience this condition.
Decompression sickness involves a dangerous loss of oxygen in the blood stream and can be both painful and fatal.
By the 1960s it was realised that HBOT might be appropriate to other conditions and illnesses and it was used for example for carbon monoxide poisoning cases and other oxygen-depletion scenarios such as gangrene. It was thus shown to increase, not just blood oxygen levels, but tissue oxygen and improve tissue healing.
There are now many other illnesses and conditions for which the idea of increasing cellular oxygen load is accepted as having significant benefits - for example ulceration (caused by radiotherapy, diabetes and so on), brain damage after accidents and plastic surgery. And, in some countries, cancer.
In 1931 Otto Warburg won a Nobel prize for explaining that oxygen was the enemy of the cancer cell. It kills them. Indeed, cancer cells thrive in an environment where oxygen is depleted (Hypoxia). The abnormal blood supplies created by tumours feature ´hypoxic pockets´ - where there is no oxygen and lower pH (a more acidic environment). These hypoxic pockets seem to protect the cancer cell from the outside world, leaving it alone to burn glucose (glycolysis) and flourish. The pH inside such tumours is highly acidic - around 6.2 pH.
Since that time many alternative cancer experts have pondered over ways of delivering oxygen to cancerous tissue in the hope of killing the cancer cells and restoring the tissue to a normal state. In our interview with Dr Contreras of The Oasis of Hope Hospital in Mexico, he told us how they were using a form of dialysis to deliver ozone to the tissues. (Note - while oxygen is a double atom molecule O2, ozone is a triple atom molecule O3). He claimed that the system was in early stages of development, but did seem to extend the lives of cancer patients already tested, by months if not by years. Today there are well respected centres operating inside the USA that use ozone to treat cancer, as a part of their offering.
To quote from a 2012 review on the previous 8 years research into HBOT (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510426/): ´research has shown that HBO can be inhibitory and reduce cancer growth in certain cancer types´.
Oxygen is a drug!
Believe it or not but oxygen has officially been declared a drug by the FDA in America who have stated that it must not be prescribed to treat anything other than those illnesses approved and for which there is evidence. For example, decompression sickness, anaemia, gangrene, skin grafts, soft tissue damage, burns, abscess in the head or brain, osteomyelitis. In effect, they have banned the use of Hyperbaric Oxygen to treat cancer. But then in 2011, they have taken steps to ban the use of intravenous vitamin C compounds, which can also increase cell oxygen levels! They don´t seem to want you oxygenating your cancer cells at all. Will eating glutathione-rich vegetables be banned next?
Could Oxygen therapy make matters worse? This was an unproven theory at one point but a 2012 review by Professors Ingrid Moerr and Linda Stuhr has shown that there is no foundation in research reviews from 2004 to 2012 that HBO acts as a stimulator of cancer or promotes recurrence (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510426/).
The reviewers add that ´on the other hand, there is evidence that HBO may have tumour-inhibitory effects in certain cancer subtypes´
HBO as a Complementary Therapy for cancer
HBOT is currently used with cancer patients to reduce inflammation in bones and adjacent tissues where radiotherapy may cause damage - it seems to have an ability to reduce secondary radiation damage after radiotherapy. For example, one research study (HYPON) showed that the use of HBOT could reduce jaw bone damage in patients given radiotherapy for head and neck cancers. Radiotherapy damages surrounding tissues, not just cancer cells.
This has actually been known for a number of years. A randomised clinical trial (Watson et al, British Journal of Radiology: http://www.ncbi.nlm.nih.gov/pubmed/361144) took place in 1978; and the same year there was a review in the Lancet which talked about ´significant´ improvement in survival when HBOT was used as a ´sensitiser´ with radiotherapy - http://www.ncbi.nlm.nih.gov/pubmed/81424
Other uses include the regeneration of blood vessels - blood supplies may be restricted to tissues and bones by the harmful action of radiotherapy; and oxygen treatment can help significantly. It has also been shown to help reduce secondary problems with both pelvic and bowel cancer. These damage reduction effects are important as up to 25 per cent of people undergoing radiotherapy can experience tissue damage according to the action group RAFGE - this is acknowledged in a clinical medicine piece:
´Hyperbaric Oxygen therapy effectively treats long-term damage from radiation therapy´
on the UCLA Health website (http://www.uclahealth.org/body.cfm?id=502&action=detail&ref=675) and even in the UK where HBOT is slowly being added to the repertoire of orthodox medicine. At the end of this article you will see that the Royal Marsden were asking for recruits to their phase III clinical trial - it was for people who experienced side effects after radiation for pelvic cancer.
There is also evidence that HBOT may help people with lymphoedema following breast cancer and lymph nodule surgery. Quite simply, oxygen therapy aids healing and patients in research talk of reduced swelling and less pain, with a softening of the damaged tissue.
What happens during HBOT?
People can be treated individually or in groups depending upon the size of the chamber. Inside, the pure oxygen is administered at pressures 1.5 to 3 times normal atmospheric pressure. Treatment time is usually about 90 minutes and only cotton clothing may be worn. There are treatment centres throughout the UK you might contact the British Hyperbaric Association.
Side effects may include claustrophobia, fatigue, headaches, ear problems and nausea. It is occasionally possible the myopia (short sightedness) occurs, and people with lung disease may experience a collapsed lung, heart patients may have symptoms worsened. It is not recommended for pregnant women.
Cancer patients taking drugs such as doxorubicin, cisplatin or bleomycin are advised not to use HBOT.
HBO as an alternative cancer treatment
Oxygen therapy, ozone therapy, the use of hydrogen peroxide and even the simple ingestion of more foods containing glutathione all have one theoretical aim: To deliver more oxygen to the mitochondria inside the cell. It is the mithochondria (the power stations) that cease their normal job of burning carbohydrate in the presence of oxygen to produce energy (the Krebs Cycle) in cancer cells. Instead cancer cells produce energy by inefficiently burning glucose in the absence of oxygen in the main cytoplasm. This ´glycolysis´ typifies a cancer cell.
While the theory is great, (get oxygen back inside the cell and the cancer will die) the research to date has been virtually non-existent. The primary problem, as Contreras told me, is the delivery system. Increasing the oxygen levels in the blood does not necessarily increase them in the cells. Also, the latest research is showing that even when you get oxygen back inside the cells, it doesn´t particularly ´re-ignite´ the mitochondrial power burners. Researchers in Alberta are looking at a compound called DCA, which they believe can do this.
HBO as a complementary therapy
Research published in June 2013 by researchers from the University of South Florida and the Boston College using mice models proved very interesting:
In mice with metastatic cancer and using a Ketogenic Diet and Hyperbaric Oxygen in combination and alone, with control groups, the researchers reported that a "Ketogenic Diet alone significantly decreased blood glucose, slowed tumour progression and increased mean survival time by 56.7% in mice with systemic metastatic cancer. While Hyperbaric Oxygen Therapy alone did not influence cancer progression, combining the Ketogenic Diet with Hyperbaric Oxygen elicited a significant decrease in blood glucose, tumour growth rate and a 77% increase in mean survival times compared to the controls.
So let us be very clear. These highly qualified researchers (Angela M Poff, Csilla Ari, Thomas N Seyfried and Dr Dominic P D´Agostino) conclude that on its own Hyperbaric Oxygen had no effect on the oxygen-devoid, acidic hypoxic pockets nor on the glucose burning cancer cells. But in combination with a Ketogenic Diet, where the body is starved of glucose, Hyperbaric Oxygen had a significant complementary effect, and it increased survival times.
Certainly, that is also what is being shown with chemotherapy. On its own HBOT does nothing. With Chemo, it produces better results AND less side-effects.
Further studies are patchy at best. There are studies with breast cancer, prostate cancer and brain tumours (largely in animal models) that show prolonged survival and a reduction in tumour size, some when in combination with drugs. There are studies involving mice who have been induced with cancer to give them oral mucosal carcinoma. Hyperbaric oxygen reduced the level of cancer, preventing some mice developing the disease. However, in some cases where the mice already had the disease, oxygen seemed to make matters worse. (The effect of hyperbaric oxygen therapy on oral mucosal carcinoma; Terry McMillan, Karen Callhoun et al).
Patients with brain tumours may well derive benefit. Treatment using HBO with brain damage has definitely shown promise, and this has now been extended to brain cancer. In a 2006 Clinical Trial in Japan, brain tumour patients receiving radiotherapy and chemotherapy experienced longer survival times and reduced side effects when using HBO. (Ogawa et al). In 2007 a second clinical trial showed extended survival times with reduced side effects using HBO with just radiotherapy in glioma patients (Kohshi et al). Now (July 2011) researchers at the Long Island Brain Tumour Centre are try to replicate those studies again in a Phase II clinical trial with gliomas. Along with the HBOT, they are using radiotherapy and temozolomide (http://clinicaltrial.gov/ct2/show/NCT00936052?term=HBO&rank=1).
Researchers at the University of Washington and Washington State University have shown that the herb artimesia vulgaris, or Wormwood, kills a cancer cells in conjunction with Hyperbaric Oxygen in early research in the 1990s. They describe wormwood as an important antimalarial drug.
Wormwood acts by reacting with iron in a cell to form a free-radical which kills the cell. Malaria parasites and cancer cells are high in iron.
New research in 2011 on a culture of leukaemia cells has shown that wormwood acts to kill about 15 per cent of cancer cells in the laboratory experiments. And they found almost the same 15 per cent figure when using HBO. Combining the two treatments say a 38 per cent reduction in cancer growth. Professor of bioengineering, Henry Lai said We only measured up to 48 hours. Over longer time periods we expect the synergistic effects to be even more dramatic.
Importantly, there are a number of cancer centres in Germany that currently use Hyperbaric Oxygen Therapy to treat cancer, sometimes as a single stand-alone therapy, but more usually in conjunction with other treatments, including either complementary therapies or chemotherapy. And, they claim excellent results.
Trawling the web I found quotes such as:
´I utilize mild Hyperbaric Therapy (mHBT) in all stages of cancer; upon detection, as well as pre and post surgery, pre, post and during chemo and radiation. In fact if chemotherapy is used in conjunction with mHBT, the chemotherapy dose must be reduced. The mHBT will potentate any primary cancer treatment. mHBT is the best cancer prevention and cancer remission therapy out there, bar none´. US Doctor, Bergeron, Rhett, MD
´By increasing the oxygen environment to the cancer cells, it makes them less virulent and in many instances destroys them´. (Yutsis, Pavel I., MD, Oxygen to the Rescue)
It is important to note that there are studies with leukemia, bladder and cervical cancers where HBOT on its own seems to have no effect:(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510426/)
So is it an alternative cancer treatment on its own?
Consistently, in my research on HBOT, I have found articles talking excellent theory, but little hard research evidence in practice until I came to the studies involving a Ketogenic Diet as well. This is not to say I am a doubter, I am not. But it is one thing telling me that oxygen kills cancer cells in my Oxford University lectures, and another thing delivery it.
Maybe the oxygen increase is not enough to stop glycolysis - the burning of glucose by cancer cells - on its own. Maybe it has to have a glucose restricted diet working in combination with it.
Maybe hitherto the delivery systems for oxygen were poor. Maybe Hyperbaric Oxygen is that delivery system - the mice in the Ketogenic Diet plus Hyperbaric Oxygen research were given 3 sessions of HBOT a week, each for 90 minutes.
I acknowledge that there are centres in Germany claiming excellent results, there are cancer experts in the USA lauding its potential. The Seyfried/ D´Agostino study concluded that ´A Ketogenic Diet and HBOT produce significant anti-cancer effects when combined in a natural model of systemic metastatic cancer. Our evidence that these therapies should be investigated as potential non-toxic treatments or adjuvant therapies (complementary therapies)´.
And research shows Hyperbaric Oxygen Therapy clearly provides real benefits as a complementary therapy when used with radiotherapy and lymphoedema to reduce side-effects and promote healing.
The great thing is that we know Hyperbaric oxygen is a healing treatment - there is already significant evidence for a variety of illnesses. And we know that it is an ´all-over-body treatment, just as cancer is an ´all-over-body´ disease. It already has staunch supporters in countries like Germany and Japan.
Cancer patients should keep an open mind on Hyperbaric Oxygen Therapy and watch for research developments.
According to websites in America (UCLA) and the UK, people may experience light headedness but this is temporary. No detrimental effects are recorded anywhere, that I could find.
Interestingly, Professor John Yarnold´s office at the Royal Marsden read this article and asked me to tell all readers that they are recruiting people for a Clinical Trial, if you would like to participate.
The trial is a randomised, double-blind, controlled Phase III trial of Hyperbaric Oxygen in patients suffering long-term adverse effects after radiotherapy for pelvic cancer.
That trial is now taking place and entry is closed.
How do you find a Hyperbaric Oxygen Centre today?
Actually access to Hyperbaric Oxygen Treatment in the UK is easier than you think. ‘Oxygen treatment’ is actually very accessible at low cost right across Britain - you don’t have to wait for your oncology unit to get a Hyperbaric Oxygen chamber!
Scattered across the UK are 60 Multiple Sclerosis Therapy Centres, all independent charities, which offer therapies and support to people with MS. Nearly all provide access to oxygen treatment (also known as oxygen therapy) which has been shown to significantly alleviate the symptoms of MS and improve quality of life. Most centres are also able to treat people with other conditions, depending on available capacity. Costs vary from £10 to £15 per one hour session.
The centres ask for donations, or set their own charges for treatment which are relatively inexpensive due to their charitable status. Treatments are delivered in multi-place barochambers (low-pressure chambers), which are pressurised to between 0.5 – 2 times normal atmospheric pressure, and a session lasts approximately 90 minutes. Referrals are not required, so any person can go to their local centre and access the treatment. Over 2½ million sessions have been delivered since the centres were founded 30 years ago, to a standard approved by the Department of Health.
According to MS experts, ´besides MS and cancer, other conditions already treated in the centres include leg ulcers, strokes, COPD, cerebral palsy, autism, wounds, migraines, sports injuries, broken bones – the list is nearly endless. Any condition which results in inflammation in the body can benefit from oxygen treatment. We all breathe oxygen all the time, but when we are ill we can use a chamber to increase the dosage of oxygen, delivering more to damaged areas in the body and stimulating the healing process. Oxygen is our body’s antibiotic; it controls over 8000 genes, and a course of 20 sessions increases our own stem cells eightfold´.
The locations of the MS Therapy Centres can be found at www.msntc.org.uk, or by calling 0845 367 0977.
The view a list of some European Hyperbaric Oxygen Centres to consider, please click this link: /cancer-active-page-link.aspx?n=3134&Title=Some
The Bottom Line
HBOT does not cure cancer. On its own it has no effect.
If you are having chemotherapy, you must consider it as it seems to make the results better.
If you are having radiotherapy, you must consider it as it reduces the level of side-effects.
And if you use it with a Ketogenic Diet, you just might have something of potential - we await the clinical trial results.
People reading this article also read (Click on links):
Dr Contreras and the Oasis of Hope
The Ketogenic Diet