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JU INSIGHT Patient-Reported Outcome Measures Following Hyperbaric Oxygen Therapy for Radiation Cystitis
By: Rachel A. Moses, MD, MPH, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Alexandra E. Hunter, BA, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Eileen R. Brandes, MD, Dartmouth Health, Lebanon, New Hampshire; Ziyin Zhang, MS, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Judy R. Rees, BM, BCh, MPH, PhD, Dartmouth Cancer Center, Lebanon, New Hampshire; Janet L. Peacock, MSc, PhD, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; William Bihrle III, MD, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Kinjal Sethuraman, MD, University of Maryland Medical Center, Baltimore; Lindell K. Weaver, MD, University of Utah School of Medicine, Salt Lake City; Jay C. Buckey Jr, MD, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire for the Multicenter Registry for Hyperbaric Oxygen Therapy Consortium | Posted on: 18 Jun 2024
Moses RA, Hunter AE, Brandes ER, et al; Multicenter Registry for Hyperbaric Oxygen Therapy Consortium. Patient-reported outcome measures following hyperbaric oxygen therapy for radiation cystitis: early results from the Multicenter Registry for Hyperbaric Oxygen Therapy. J Urol. 2024;211(6):765-774. doi:10.1097/JU.0000000000003929
Study Need and Importance
A growing number of pelvic malignancy survivors who have undergone primary or secondary radiation therapy will develop radiation cystitis (RC), manifesting in recurrent, clinically significant hematuria and potentially debilitating lower urinary tract symptoms. Hyperbaric oxygen (HBO2) therapy is the only noninvasive, severe RC treatment option associated with fewer bladder bleeding events; however, little is understood surrounding optimal HBO2 timing, duration, and overall efficacy. The few published RC HBO2 studies are limited by small sample sizes and limited reported data on patient-reported outcomes.
What We Found
In this study we compared prospectively collected Radiation Therapy Oncology Group Hematuria Scale, Urinary Distress Inventory Short Form, and EuroQol Five Dimension Five Level instrument from participants presenting with RC within a week before and after completing HBO2 in the Multicenter Registry for Hyperbaric Oxygen Therapy Consortium. We found participants undergoing a median of 39 HBO2 sessions reported improved hematuria (Figure), urinary function, and quality of life. Higher baseline hematuria scores, smoking, and nonprostate cancer history were associated with lower odds of hematuria improvement.
Limitations
This study was limited by the lack of a comparison control arm and a validated RC-specific patient-reported outcomes measure, as well as by a focus on short-term outcomes. Not all participants completed each of the 3 measures; however, demographic data between groups were similar. Further, the cohort primarily consisted of males with a prostate cancer history, which may limit generalizability to other RC cohorts.
Interpretation for Patient Care
This study demonstrates improved short-term patient-reported hematuria, urinary function, and quality of life in a large prospective cohort receiving HBO2 for RC. Notably, individuals with higher baseline Radiation Therapy Oncology Group hematuria scores, a history of smoking, and treatment for nonprostate cancer had lower odds of hematuria improvement. These findings may be incorporated into RC treatment option shared decision-making.
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