hello and thanks for watching this is dr phil harrington with laser lessons from dr phil my topic today can i laser a patient with cancer as always feel free to contact me if you have my other modes of contact information you're certainly welcome to reach me that way or through my laser lessons from dr phil at gmail.com email address so the past 15 years of being the medical director for a class 4 therapeutic laser company one of the most difficult yet most frequent questions that i have to answer is i've got a patient with cancer can i use the laser on them and you see a few examples here of questions that come in these have were emailed to me just in the last month and some of these questions can be very difficult and complicated and this presentation it's not a very long presentation but i will try to answer that question can you laser a patient that either has a history of cancer or has active cancer and then also where would you use the laser on them could you use it potentially over the cancerous site itself so let's dive into this and here we go now when i teach my ce classes on risk management and when i talk about this topic of using a laser on a patient with a history of cancer and the same logic applies to using the laser on a pregnant patient or other risk management topics there are many reasons why we do or do not do things now let's just imagine that you and i are in person speaking face to face and when i'm teaching a ce lecture i will pick someone out in the classroom and i will just walk up to them and ask them why don't i punch you in the face right now now there's many answers for that question you could hit me back the other people in the room would certainly come to your defense doing this is assault and i would be charged and arrested it's simply not nice and i'm a nice person it would hurt my hand i like you you're my friend and there could be other reasons so i've just listed six reasons there and that's the kind of logic that i'm wanting us to think about when it comes to using the laser on a patient with a history of cancer and so i divide this into two categories on the left side it's going to be the scientific physiological maybe you could even call that real world it's what i would do for my family and for myself and there you see me pictured with my two daughters so when i answer in that fashion when i answer over here that's you know what i would do for myself and for my family and then on the right hand side is the medical legal and the liability reasons and on that side in the right hand side it's what i would do to protect my liability and my license to practice so realize that when we answer the question can you treat a patient with cancer there are two ways to answer that and there are reasons why we do it that way so first let's take a look at photobiomodulation laser therapy photobiomodulation and cancer what do the studies show so i will go through a fairly quick summary of what the current published research says now of course you can pause the video and get the name of the article and if you can look it up you know by yourself or if you want to ask me for it i'll be happy to share with you so let's take a look at these studies this first one is from one of the top laser journal lasers in surgery and medicine from 2015 selective cytotoxic effects of laser on human oral cancer cells and going straight to the conclusion our findings imply that low power laser radiation might be a potential therapy for oral cancers now just a side note here they are using the term low power laser irradiation i have other videos on my laser lessons from dr phil's site where i talk about uh you know why is it called cold laser and the whole history of terminology used for laser therapy or photobiomodulation i guess just understand that we're talking about essentially the same thing here you can if you look in the materials and methods you see they're using a wavelength of 810 nanometers and a energy density or dosage of 10 to joule 60 joules per square centimeter so once again their findings indicate that photobiomodulation could be a potential therapy for oral cancers in other words use laser therapy to actively treat cancer this paper was a small animal study done with mice titled laser therapy inhibits tumor growth in mice by promoting immune surveillance and vessel normalization and so that's something that we've known from the tissue biological effects of laser therapy is that treatment with the laser stimulates a local immune response so let's look at this paper says while laser light increased cell metabolism in cultured cells the in vivo outcome was reduced tumor progression this striking unexpected result was paralleled by the recruitment of immune cells in particular t lymphocytes and dendritic cells which secreted type 1 interferons so they are saying that they took these tumor cells and put them in a petri dish and yes exposure to the laser did increase the cell metabolism of the cancer cells in vitro however the outcome in vivo was reduced tumor progress and they go on to say collectively our results clearly indicate that any experiment assessing the effect of laser light and culture cells is not representative of the individual condition because they got as i just said you know with with the uh in vitro results increased tumor cell growth in vivo results decreased tumor cell growth very interesting another study on the cost effectiveness of laser therapy in head and neck cancer patients receiving concurrent chemo radiation the conclusions our results indicate that morbidity was lower in the laser group and that laser therapy was more cost effective than placebo up to a threshold of at least five thousand dollars per mucosa mucositis case prevented so in other words these cancer patients undergoing chemotherapy it's about 50 percent when you have someone who is undergoing chemotherapy about half of them will develop oral mucositis and so here they are showing that yes when this patient has active oral head and neck cancer they are using laser therapy as an active treatment for the oral mucositis and the morbidity was lower in the laser in the systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines the conclusion the evidence supports the use of specific settings of photobiomodulation for the prevention of hormocositis in specific patient populations so once again similar topic here patient has cancer they are undergoing chemotherapy and they are recommending that photobiomodulation is used on those patients with active cancer this paper is entitled photobiomodulation in cancer what is the truth and the primary author is dr michael hamblin who is who had been the fellow at the wellman center for photo medicine associated with harvard medical school and he concludes photobiomodulation therapy may have benefits in cancer patients and should be further investigated and in the paper they talk about different effects where in this figure as they show cancer therapy side effects that could possibly be treated with photobiomodulation so in other words this patient has cancer they are undergoing a cancer treatment and dr hamblin is suggesting that while they are undergoing the cancer therapy that they receive photobiomodulation treatments as a treatment for these side effects now we see this quite a bit he's got peripheral neuropathy listed there we have studies that show that class iv laser therapy is greater than 90 percent effective at resolution of symptoms at least helping the reduced modified total neuropathy scores of patients with chemotherapy induced peripheral neuropathy and so again here in this paper dr hamblin is arguing that laser therapy should be possibly used as a treatment for these cancer side effects another paper the role of photobiomodulation in the care of cancer patients the findings suggest that photobiomodulation therapy is a promising option for the management of these cancer therapy related side effects impact of photobiomodulation in the patient derived xenograft model of oral squamous cell carcinoma the conclusion in this study photomyomodulation did not impact the behavior of the models this is an important preclinical outcome regarding safety concerns of the use of photobiomodulation in cancer patients so once again if you uh you know want to look up this article or or contact me i'd be happy to share a full copy of it with you but this study and and essentially all of them that i just went through indicate that photobiomodulation is safe to use for these cancer patients and some of them are are arguing that it is should be used as an active treatment so going back to this slide that i started out with i would say this from the scientific physiological real world experience if any member of my family had cancer of any type i would not hesitate to laser them if i was diagnosed with any type of cancer regardless i would laser myself and yes i would laser directly over the tumor site and that goes for any of any member of my family that's that's my advice however medical legal liability protect your license you have to think about worst case scenario if you do use the laser on this patient and worst case scenario their cancer worsens or worse yet they die down the road will you get blamed so when answering from that standpoint of protecting your liability and your license i would say that if the standard patient has or has had cancer i would not laser them so you've seen the evidence in the end you will have to decide i'm not going to tell you what to do in this case i've shared the evidence with you i've told you what i would do with my myself and my family and i've told you what i would do with patience this is dr phil harrington with laser lessons from dr phil thank you for watching and have a good day you