Hyperbaric oxygen therapy in patients with hemorrhagic radiation cystitis
A population- based, retrospective cohort study
DOI:
https://doi.org/10.5489/cuaj.9680Keywords:
Access to Healthcare, radiotherapy, hemorrhagic cystitis, hyperbaric oxygen therapy, emergency urologyAbstract
Introduction: Hyperbaric oxygen therapy (HBOT) can be used to manage hemorrhagic radiation cystitis, although small studies demonstrate variable effectiveness. This study aimed to evaluate the epidemiology, predictors, and clinical effectiveness of HBOT using a large population-based cohort.
Methods: A retrospective cohort study of pelvic cancer patients with post-radiotherapy (RT) hemorrhagic cystitis in Ontario, Canada (2002−2021). HBOT users and non-users were followed for at least one year post-treatment, March 2024, or death. We measured HBOT use, identified predictors via logistic regression, and compared healthcare outcomes (emergency visits, hospitalizations, procedures, and blood transfusions) using multivariate difference-in-difference analysis at one- and three-year intervals.
Results: Among post-RT pelvic cancer patients with hemorrhagic cystitis, HBOT use was 1.4% (707/51 714). Older age, non-prostate/cervical malignancy, lower income, and greater distance to center were associated with less HBOT use. The rate of emergency visits (3.3, 95% confidence interval [CI] 3.2−3.4 vs. 1.8, 95% CI 1.7−1.9 visits per person; p<0.001), hospitalizations (0.9, 95% CI 0.9−1.0 vs. 0.6, 95% CI 0.5−0.6 visits per person; p<0.001), procedures (2.8, 95% CI 2.6−2.9 vs. 1.1, 95% CI 1.0−1.2 procedures per person; p<0.001), and blood transfusions (0.6, 95% CI 0.6−0.7 vs. 0.5, 95% CI 0.4−0.5 transfusions per person; p<0.001) all significantly decreased one year post-HBOT, with sustained effects at three years.
Conclusions: At one- and three-year followups, HBOT use was associated with significant reductions in emergency visits, hospitalizations, procedures, and transfusions among a large cohort with post-RT hemorrhagic cystitis. These findings support the consideration of HBOT as an effective therapeutic option in this population, though persistent access disparities highlight the need for targeted interventions and further study.
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