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Hyperbaric Oxygen Therapy for the Management of Lymphedema Symptoms

Lymphedema is a chronic medical condition characterized by swelling, frequently in the arms and/or legs, as the result of inadequate lymphatic drainage. Lymphedema frequently occurs following lymph node resection, chemotherapy and/or radiation therapy during breast cancer treatment. Approved therapeutic approaches involve lymphatic massage, use of compression garments and corrective exercise. While all of these modalities have been proven effective, they may not work as well for some patients as others (Teas et al., 2004). Once lymphedema progresses to fibrosis, it becomes more difficult to treat, resulting in significant functional limitations for those affected, and understandably, increased levels of anxiety and depression.

Several studies indicate that hyperbaric oxygen therapy (HBOT) may be a useful adjunct to existing lymphedema treatments. A 2004 study on 10 post-menopausal women with lymphedema occurring as a result of breast cancer treatment found a significant reduction in swelling in the hands (Teas et al., 2004). In a more recent study, short-term hyperbaric oxygen therapy was used in combination with complex decongestive therapy (standard lymphedema treatment) on ten patients, with results compared to a control group undergoing complex decongestive therapy alone. While both groups experienced symptom improvement, the HBOT group had better outcomes as measured by bioimpedance spectroscopy and lymphedema-specific quality of life questionnaires (Koo et al., 2020).

Although scientists remain somewhat uncertain as to how HBOT works to improve lymphedema symptoms, they believe it may have to do with increased levels of vascular endothelial growth factor or VEGF (Teas et al., 2004). VEGF is a signaling protein involved in the creation and growth of new blood vessels. During lymph node resection and radiation therapy, existing capillary networks become damaged. Because the circulatory system is essential for delivering oxygen to vital tissues and organs throughout the body, any areas in which the vascular network is damaged can become hypoxic (starved for oxygen). When cells are deprived of oxygen they cannot metabolize energy from blood sugar as effectively, and because of that, these cells frequently sustain permanent damage or in some cases, the cells die.

In addition to promoting growth of healthy vascular tissue, HBOT delivers significantly more oxygen to the body than what normally occurs breathing atmospheric air at sea level. Oxygen content in the atmosphere is about 20%, whereas in HBOT the patient is breathing pure oxygen. In addition, the hyperbaric chamber is pressurized to 1.3-3.0 ATA (sea level atmospheric pressure is 1.0 ATA). The combination of the pressurized chamber and pure oxygen results in blood plasma absorbing a much higher oxygen content than normal. This super-oxygenated blood is very therapeutic in healing damaged tissues.

Although the research studies described above used relatively short treatment protocols, most literature indicates that patients receive maximum benefit from multiple treatments (up to 20). Hyperbaric oxygen therapy has been approved by the FDA for a variety of conditions ranging from carbon monoxide poisoning to necrotic tissue injury, and is considered safe and effective for treatments lasting up to two hours at pressures up to 3.0 ATA (Tibbles & Edelsberg, 1996).

Hyperbaric Oxygen Therapy Treatment Protocol

There are two types of hyperbaric chambers: multiplace units that hold up to eight patients and an overseer, typically found in tertiary facilities such as hospitals, and monoplace units that hold a single individual (Schaefer, 1992). Because of their reduced cost and portability, monoplace units are more common in outpatient settings

A typical treatment lasts about 90 minutes: 15 minutes at each end for chamber compression and decompression, and 60 minutes of treatment. Similar to being on an airplane, the patient may experience some pressure build-up in the ears. Clearing the ears should eliminate any discomfort. Individuals experiencing chronic inner ear problems or sinus infections should notify the provider ahead of treatment. In addition, persons who are uncomfortable in confined spaces (claustrophobia) may need to use relaxation techniques to make the experience more comfortable. The machine makes some noise, but most patients are able to read and relax during treatment. An intercom enables the patient inside the chamber to communicate with his or her provider.

References

Koo, J. et al. (2020). Comparison of the short-term effects of hyperbaric oxygen therapy and complex decongestive therapy on breast cancer-related lymphedema: a pilot study. Medicine: open, 99 (11), 1-5. https://doi.org/10.1097/MD.00000000000.19564

Schaefer, S. (1992). Fundamentals of hyperbaric oxygen therapy. Orthopaedic Nursing, 11(6), 9-15.

Teas, J. et al. (2004). Can hyperbaric oxygen therapy reduce breast cancer treatment-related lymphedema? A pilot study. Journal of Women’s Health, 13(9), 1008-1018.

Tibbles, P. & Edelsberg, J. (1996). Hyperbaric oxygen therapy. New England Journal of Medicine, 334(5), 1642-1648.