When Andrew Delf was told treatment for his prostate cancer had been successful, he felt an overwhelming sense of relief.
The 47-year-old hospital porter had been diagnosed with the disease in 2010 and had undergone radiotherapy to treat an aggressive tumour.
However, six months after the radiotherapy he had heavy rectal bleeding. His cancer specialist explained this was due to the radiotherapy having damaged blood vessels in his bowel.
Andrew was prescribed iron pills, but over the next few months found that the bleeding, though painless, was occurring more often, leaving him anaemic and drained of energy.
‘I would come home after work and crash out,’ says Andrew, who lives in Bury St Edmunds, Suffolk, with his wife Clare, 40. ‘I had to stop running as I just didn’t have the energy.’
The symptoms also left him extremely self-conscious. ‘When I went out I would take a change of clothes just in case, and I was very worried that a bleed would happen at work.’
He had been referred to the Royal Marsden Hospital in London, which specialises in treating the side-effects of radiation therapy.
He was offered what seemed an unlikely treatment: sessions of sitting in a pressurised diving chamber, wearing an oxygen mask.
Though doctors are unsure how it works, one theory is that increased oxygen levels trigger the release of stem cells from the bone marrow. These have the ability to change into any cell of the body, and can aid healing.
Andrew had the treatment for two hours a day for eight weeks, sharing the diving chamber with seven other people at a time.
‘I got to know other patients and read novels to pass the time,’ he says. ‘I noticed halfway through the course that the bleeds became less frequent and since finishing the treatment at the beginning of April I haven’t had any.
‘I feel great and have even started running again.’
Andrew’s symptoms were caused by pelvic radiation disease, where radiotherapy for a cancer in the pelvic area causes damage to surrounding tissue, such as the bladder, bowel or sexual organs. The condition can occur after treatment for prostate, bladder, bowel, ovarian, cervical or testicular cancer.
It is thought to affect up to half of all patients who receive radiotherapy for these cancers, though many will not suffer as severely as Andrew did.
‘Radiotherapy saves countless lives, but some of the healthy tissue will usually be harmed to ensure you’ve killed all the tumour cells,’ says Dr Jervoise Andreyev, a consultant gastroenterologist at the Royal Marsden and a specialist in pelvic radiation disease.
He says the condition is less likely with modern radiotherapy techniques because these minimise damage to healthy tissue.
However, pelvic radiation disease can arise years or even decades after the radiotherapy.
Older radiotherapy techniques tended to use just one beam of energy (rather than lots of weaker beams targeted on the tumour, as Andrew had).
This meant that any healthy tissue in the path of the beam could suffer significant damage.
The most common symptoms of pelvic radiation disease are bleeding from the bowel, incontinence, leaking from the bladder, erectile dysfunction or narrowing of the vagina. Though there are various drugs and approaches that can ease symptoms, some patients do not respond to treatment.
It is these patients who may be helped by a diving chamber, says Dr Andreyev.
In many cases, the symptoms are thought to be caused by damage to the tissue, blood vessels or nerves in the bowel or pelvis.
A U.S. study of 120 patients looked at the use of hyperbaric oxygen to treat pelvic radiation disease.‘ The results showed 90 per cent of patients had a good response,’ says Dr Andreyev.
The Royal Marsden has just completed a study into the benefits, involving 75 patients.
The results of the study, led by John Yarnold, professor of clinical oncology from the Institute of Cancer Research in London, will be published early next year.
There are only a handful of medical hyperbaric chambers across the country, and the treatment costs £10,000 per patient.
For the treatment to continue to receive NHS funding, more evidence needs to emerge to prove its effectiveness, says Professor Yarnold.