At-Home Photobiomodulation Treatments for Supportive Cancer Care During the COVID-19 Pandemic

The COVID-19 pandemic has dramatically changed lifestyles worldwide, due to the need of limiting interpersonal contacts to reduce the possibility of cross-infection and decrease the virus basic reproduction number (R0). Although social distancing is clearly a necessary public health directive, medical and psychological problems related to these lifestyle changes are having significant impact on work, family relationships, and leisure. The significant impact on overall health is becoming apparent. In fact, due to hospital conversion into COVID intensive care structures during the pandemic peak, chronically ill patients were advised to avoid, whenever possible, hospitalization and access to clinical facilities due to the risk of nosocomial infections. Among these chronically ill patients, cancer patients whose immunological resilience is often compromised and who are highly dependent on the availability of medical resources represent an extremely vulnerable population. A recent article outlined the heightened susceptibility of cancer patients, who have also been reported as having a higher risk of contracting COVID-19: ¹ many of these patients require urgent medical invasive examinations, such as biopsies, endoscopies, thoracic or oral and maxillofacial surgery, and/or oncological emergencies. ² The authors of the article also identified several intermediate risk factors that require medical attention such as oral/pulmonary function tests and/or respiratory examinations. Therefore, a major current challenge is the approach to support these cancer patients and continue their critical care during the pandemic. ³

In several of these urgent supportive cancer care treatments, a major complication in oncological patients treated with radio- and chemotherapy as well as stem cell transplants is oral mucositis. ^{4 –6} Oral mucositis compromises general health, by limiting the ability to eat, drink, speak, and swallow as well as inducing pain, inflammation, or tissue breakdown. In addition to cancer, there are many chronic conditions that need frequent hospital treatments, such as diabetes, neurological diseases, and oral lesions as Oral Lichen Planus and pemphigus or pemphigoid. Photobiomodulation (PBM), in addition to being considered a potential treatment for pandemic coronavirus infections ^{7 –10} has been demonstrated as an effective treatment for oral lesions ^{11 –13} without any contraindications or side effects. However, PBM therapy requires multiple sessions with a frequency of two or three times/week, and in some cases even daily. ¹⁴ To allow the patients to have their treatment without going to the therapist, a new family of PBM laser devices has recently appeared on the market: most popular of them emit in the near IR portion of the spectrum at 808 nm and a green LED aiming beam indicates the irradiated zone of 4.5 cm²; the output power of 250 mW is released in micropulses with a frequency of 15 kHz, an energy per minute of 14.4 J, and a Fluence per minute of 3.2 J/cm².

Owing to their classification as class II American National Standard Institute (ANSI), they may be used directly by patients themselves without the need for protective goggles in a very simple way, thanks to the preset parameters: only the irradiation time is adjustable and this may help the therapist to suggest to the appropriate choice to the patient, based on the kind of disease and different size and skin color; moreover, size and cost are reduced and the risk of side effects and contraindications is absent; nevertheless, evaluation of the patients by a specialist is mandatory. ¹⁵

“At-home photobiomodulation” treatment has been described, for example, for temporomandibular disorders, using preset devices and therapies set by the therapist, thus limiting the discomfort of repeated appointments and obtaining good results in terms of pain reduction. ¹⁶ Some case reports were also described for the treatment of neurological face diseases, also related to an intraosseous implant for prosthetic rehabilitation ¹⁷ and also for vascular lesions in diabetic leg. ^18,19 We think that the utilization of these autoadministered PBM devices may be a great help in the treatment, even only symptomatic, of many chronic diseases without going to hospitals, thus avoiding the risk of infection in compromised patients.