Oral mucositis is a common side effect of high-dose chemotherapy or radiotherapy, leaving many patients unable to eat, drink, or swallow and consequently requiring tube feeding.
Until recently, there had been no satisfactory treatment or method of prevention. However, Photobiomodulation (PBM), a light therapy treatment proven safe and effective by the National Institute for Health and Care Excellence (NICE), is now widely used across the NHS with incredible results.
Jenny Gale, a head and neck clinical nurse specialist at East Suffolk and North Essex NHS Trust, said: “It can really make your mouth sore, and it hurts to swallow, which can make eating and drinking difficult, as well as impacting your general wellbeing.”
She added: “PBM is completely painless and very simple to carry out; most patients can do it themselves.
“Evidence shows patients need less pain relief when they’ve had PBM, and they generally cope with their treatment better. It’s really exciting that we are offering it in our hospitals now.”
The breakthrough allowing NHS adoption of PBM is due to the development of the THOR LED lollipop, which patients use by placing it in their mouth for 60 seconds on the tongue and 60 seconds under the tongue.
Photobiomodulation is a low-intensity light therapy that stimulates mitochondria to produce more energy (ATP) and reduce inflammation, rapidly reducing pain and improving healing rates.
It can be used prophylactically to prevent the incidence and severity of oral mucositis or therapeutically after mucositis has developed.
Both the Christie and Leeds Cancer Centres found that PBM reduced morphine prescriptions by 63 per cent and 45 per cent, respectively, in their audits and reduced hospital bed days by 88.7 per cent at Christie and hospitalisation by 89 per cent at Leeds.
There is a rare opportunity to attend the World Association for Photobiomodulation conference, which will be held in London this year from August 23 to 25, where many NHS users of PBM will be presenting their data and discussing it one-on-one with delegates.
“James was very engaging and knowledgeable about the equipment, what happens at a cellular level, the physics of the interactions etc. It was good to see the other uses for the PBM unit and gave me ideas for other things that we could try too. James was open in his discussion and acknowledged his obvious bias to the device, but was realistic of it’s potential.”
Nicola Freeman
Consultant radiographer
Leicester, UK
Cancer survivors are getting their lives back – thanks to a trail-blazing initiative at a bespoke post-cancer service at Nottingham City Hospital.
Nottingham Macmillan Late Effects helps people manage the physical, the psychological, and the psychosexual consequences of cancer treatment – and is the only place in the UK using photobiomodulation (PBM) therapy to treat the long-term effects of radiotherapy.
Cindy Martin, 64, who was left with disfiguring scars after surgery for stage 4 cancer of the saliva gland, says PBM therapy has given her back her life.
“The radiotherapy was so intense, my skin became necrotic. By the time I found Late Effects, I was convinced I would always have open wounds on my face.”
Radiation-induced fibrosis – or tissue scarring – is completely unavoidable and can develop in the area being treated with radiotherapy years after the radiotherapy has stopped – with life-changing effects on patients.
“Looking through photographs from a year ago, my face was awful. Skin would come off in clumps, and I lost my earlobe. It affected my mobility – it was like I had a steel rod in my neck,” says Cindy.
Many patients are being cured of their cancer, but left with disabling and debilitating consequences.
“All my identity had been taken away,” says Cindy. “I couldn’t do my job any more, I’d lost loads of weight, and I looked different.”
The PBM machine has a large ‘shower head’ attachment with LED lights. Patients are trained to administer the treatment themselves. The therapy is quick, simple, non-invasive, drug-free, and doesn’t cause any pain.
Emma Hallam is a Consultant Therapeutic Radiographer at Nottingham University Hospitals NHS Trust – and the person who thought of using PBM on radiation-induced fibrosis; it is usually used to treat lymphoedema – a long-term (chronic) condition that causes swelling.
Emma says: “We have people who have survivor’s guilt – they say that they feel lucky to be alive but sometimes wish that they hadn’t survived due to the long-term – sometimes disabling – side effects.
“Head and neck patients get much more radiation-induced fibrosis – they can’t eat, they can’t drink, can’t sleep – due to dry mouths and thick secretions.
“Our holistic approach helps improve quality of life and address all our patients’ needs, including the physical, psychological and psychosexual.”
PBM is just a small part of the Late Effects Service. The service uses a multi-disciplinary collaborative approach, with a dedicated rehabilitation and follow-up clinic, therapeutic radiographers, dieticians, and speech and language therapists.
“We are getting people swallowing again, who haven’t swallowed in years, people whose necks were immobile moving again, and people who haven’t been out of the house in years going out because they have got their lives back.”
Emma nominated colleague Kerry Clark for the The Skills for Health Our Heroes Clinical Support Worker of the Year award – and she is a finalist.
Kerry said: “It is such a humbling experience and a privilege to be able to offer help and support to patients who are feeling at such a loss after cancer treatment has ended.
“It is such a supportive environment to work in – I love my job and the difference we make to patients.”
And Cindy agrees. “Emma and her team have made such a difference to my life, I just can’t thank them enough – I wouldn’t be here today if it wasn’t for them. I was alive but I wasn’t living.”
The Skills for Health Our Health Heroes Awards is sponsored by NHS England, NHS Employers, NHS Shared Business Services and more. Gold, silver and bronze Clinical Support Worker of the Year award winners will be announced at a ceremony in London on 16 April. Show your support for Kerry by casting your vote here:
Emma now leads on the early management of all head and neck lymphedema, under the expert guidance of the specialist lymphedema team.
Late Effects has developed patient questionnaires as a 10-year monitoring system; identifying late effects early is important as fibrosis becomes more resistant to therapy as it builds up.
Peer-to-peer knowledge sharing across the world, and working with patients and UK charities has been key to educating people of the need for late effects services; Nottingham has been pivotal in helping establish around 20 similar services across the UK, and helped create best practice guidelines with the Pelvic Radiation Disease Association. Emma and her team hope to work with head and neck cancer charities and other late effects services to produce best practice guidelines for this patient group.
We are having great results from our THOR equipment. The week before last I had a chap in who’s had knee problems for ever and has only been able to ski half days since his last operation 4 years ago. I used THOR Giant Laser Cluster (GLC) on him (as well as some other stuff) before he went off skiing last week and he came in yesterday to tell me he was able to ski for full days all last week for the first time in about 4 years!!!… and asking for “a top up” before he heads back out on Saturday.
He was convinced it was due to the GLC – but I had encouraged him to use NovoTHOR a few times before he went out too so I presume it was a bit of both.
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