Letters to the Editor: Radiation Enteritis: Another Consideration
Dear Editor,
As a wound care nurse with experience in acute care, long-term care, and wound care clinic settings, I was disappointed that hyperbaric oxygen therapy (HBOT) was not listed as a treatment standard in a recent “The Ostomy Files” (Turnbull G. Radiation enteritis in the patient with a fecal ostomy. Ostomy Wound Manage. 2007;53[9]:10-12). Many publications and a section from the Medicare Coverage Database reference HBOT as an adjunctive treatment in the plan of care for soft tissue and bony radiation tissue damage. From John J. Feldmeier, DO, Chairman and Editor of The Hyperbaric Oxygen Therapy Committee Report: Indications and Results (2003): “Nine clinical papers reporting the results of hyperbaric oxygen in the treatment of enteritis or proctitis have been identified in a recent review...these publications present some 105 cases ... 34 of these patients were treated with complete resolution while another 67 had improved symptoms, and only 4% of patients had no benefit.” While there is no cure for every patient, it would be a serious omission to miss an opportunity to improve both clinical outcomes and quality of life for patients who have such a difficult and challenging complication from a necessary treatment. Many in the wound care nursing community are only just becoming aware of the benefits of HBOT and have not yet embraced this technology. We need as much information as possible to achieve that goal we hold so dear: helping and serving our patients. –Angela Box Peterson, RN, WCC Charge Nurse, Baptist Princeton Medical Center Wound Care and Hyperbaric Medicine Birmingham, AL
Reply
While the intent of the column was to focus on the local management of a fecal ostomy in a patient suffering from radiation enteritis, you are correct in reminding healthcare professionals to be open to existing and emerging technologies and treatments.
Several technology assessments have been conducted on available evidence to support the use of HBOT for delayed radiation injuries and other emerging applications.1 In 2005, the Undersea and Hyperbaric Oxygen Medical Society recognized HBOT for 13 specific conditions including delayed radiation injury (soft tissue and bony radiation necrosis).2 In a review of the literature in 2004, Feldmeier3 stated that HBOT had “shown consistent benefit in treating patients with delayed radiation injury.”
While some payors continue to consider HBOT “experimental and investigational” for this indication and others cover it as medically necessary, additional studies and publications are required. As previously evidenced by other advances in treatment and technologies for wound, ostomy, and skin care, continued investigation and dialogue must be ongoing. –Gwen B. Turnbull, RN
This article was not subject to the Ostomy Wound Management peer-review process.
1. Aetna #0172. Clinical Policy Bulletin: Hyperbaric Oxygen Therapy. October 2, 2007. Available at: www.aetna.com. Accessed November 7, 2007.
2. The Undersea and Hyperbaric Medical Society (UHMS). Hyperbaric Oxygen Therapy Committee. Guidelines. Indications for Hyperbaric Oxygen. Kensington, Md: UHMS; 2000. Available at: http://www.uhms.org/Indications/indications.htm. Accessed November 7, 2007.
3. Feldmeier JJ. Hyperbaric oxygen for delayed radiation injuries. Undersea Hyperb Med.2004;31(1):133-145.
