Is hyperbaric oxygen therapy (HBOT) contraindicated in patients with colon cancer?

Hyperbaric Oxygen Therapy in Patients with Colon Cancer

Hyperbaric oxygen therapy (HBOT) is not contraindicated in patients with colon cancer and can be safely used when clinically indicated.

Safety of HBOT in Cancer Patients

• Recent evidence suggests HBOT does not promote tumor growth or recurrence in patients with solid tumors, including colorectal cancer 1
• A 2025 study following patients with solid tumors who underwent HBOT found no significant correlations between number of HBOT sessions and cancer metastasis or mortality 1
• Experimental studies in animal models have shown that HBOT does not stimulate growth of colorectal liver metastases and may potentially be used safely alongside other therapeutic modalities 2
• HBOT has even demonstrated potential anti-inflammatory effects that could reduce colorectal carcinogenesis by reverting COX-2 expression to normal levels 3

Clinical Applications of HBOT in Patients with Cancer History

Radiation-Induced Complications

• HBOT is recognized as a treatment option for radiation-induced proctitis, which can occur after pelvic radiotherapy for various cancers including colorectal cancer 4
• The British Society of Gastroenterology (2025) lists HBOT as a definitive treatment option for radiation-induced telangiectasia causing rectal bleeding 4
• HBOT induces neo-vascularization, tissue re-oxygenation, collagen neo-deposition, and fibroblast proliferation, eliciting responses in the majority of patients with chronic proctitis 4

Treatment Protocol Considerations

• For radiation-induced proctitis, patients typically require at least 30 sessions of HBOT to see significant benefit 4
• Lower-pressure HBO as used in chambers treating people with multiple sclerosis is probably ineffective for treating radiation-induced injury 4
• The main disadvantage of HBOT is that it is time-consuming for patients 4

Evidence Quality and Limitations

• While some randomized trials show contradictory results regarding HBOT for radiation proctopathy, the HOT2 study showed a trend toward benefit (p=0.09), and the HORTIS IV study demonstrated greater healing in patients receiving HBO versus sham therapy 4
• A review indicated that HBOT may improve outcomes for radiation proctitis, but further studies are necessary to establish correct patient selection criteria 4
• The 2018 Gut publication identified a need for more research on HBOT for symptom management in colorectal cancer patients but did not contraindicate its use 4

Clinical Decision Algorithm

1. Assess indication for HBOT:

   • Determine if patient has a valid indication (e.g., radiation proctitis, wound healing complications) 4
   • Confirm diagnosis with appropriate investigations (e.g., flexible sigmoidoscopy for rectal bleeding) 4

2. Evaluate patient-specific factors:

   • Consider cancer status (active vs. remission) 1
   • Assess overall health status and ability to tolerate multiple HBOT sessions 4

3. Implement HBOT when indicated:

   • For radiation proctitis, plan for at least 30 sessions at appropriate pressure (not low-pressure) 4
   • Monitor for clinical response during treatment course 4

4. Follow-up:

   • Continue regular oncological surveillance as per standard protocols 1
   • Monitor for symptom improvement related to the indication for HBOT 4

Common Pitfalls to Avoid

• Do not withhold HBOT solely due to history of colon cancer when there is a valid clinical indication 5, 1
• Avoid biopsy of irradiated mucosa when evaluating for radiation proctitis, as this carries risk of fistula development or necrosis 4
• Be cautious with argon plasma coagulation in radiation proctopathy, as complication rates can be as high as 26% 4
• Ensure patients understand that HBOT requires commitment to multiple sessions, as benefits may not be apparent until completion of a full treatment course 4