Bill Klaproth (Host): This is the Living Well with Eisenhower Health podcast, healthcare as it should be. I'm Bill Klaproth. And joining me today is Dr. Kamal Patel, Medical Director of BIGHORN Radiation Oncology Center at the Eisenhower Lucy Curci Cancer Center, as we talk about low-dose radiation therapy, a new treatment option for those who suffer from osteoarthritis. Dr. Patel, welcome.

Dr. Kamal Patel: Hey, Bill. Thank you for having me.

Host: Thank you, Dr. Patel. Interested to talk to you about this. So, let's start with the basics. What exactly is osteoarthritis and what's happening in the joint when someone has it?

Dr. Kamal Patel: Osteoarthritis affects over 30 million Americans, and it's the second leading cause of disability in adults. About one in seven Americans will be diagnosed with osteoarthritis. Osteoarthritis is really an inflammatory response in the joint that can cause pain and even decrease mobility.

Host: So, I know there are a number of ways to manage osteoarthritis. So, where does low-dose radiation therapy fit in, and why can it be so effective for some patients?

Dr. Kamal Patel: The good news is we're actually a complement to all the treatments that are out there for all our patients. It's not necessarily a substitute for, but it's a complement to everything, and it can fit in pretty much anywhere along the scale whenever a primary care physician, an orthopedic surgeon, a sports medicine, a pain physician feels it would be appropriate.

For us, typically, the earlier we interact with these patients, the better the outcomes. But we can be involved at any point along their scale, from early osteoarthritis to more advanced disease.

Host: So, I think when someone hears the term radiation, they may immediately have concerns. So, how safe is the treatment, and are there any side effects or risks patients should know about?

Dr. Kamal Patel: Absolutely. The word radiation can be very frightening, intimidating, very scary. And the real key is we're saying low dose. And typically, for our cancer patients, we're using normal dose or high dose. And at that level, we're really trying to kill the cancer. And interestingly enough, when we use low dose, the radiobiology is completely different.

It's like a day and night difference. With high dose, we're really causing damage to the cancer cells. With low dose, it's really causing a healing effect. So, what we're doing is we're decreasing the inflammation at a low dose. We're causing pain to become less, and that's just because of the way radiation works at a low dose versus the high dose we give our cancer patients.

And in terms of how do our patients do, it's extremely well-tolerated. There's data that really came out of Europe specifically in Germany, where they treat about 15,000 patients a year. And what they've noticed is this treatment is highly effective and well-tolerated. And so, that's why it's come back into the United States, and it's gaining a lot of momentum.

Host: So, the key is low dose, and low dose has a healing effect, and it's well-tolerated. So Dr. Patel, who tends to be a good candidate for low-dose radiation therapy, and are there certain types or stages of osteoarthritis where it works best?

Dr. Kamal Patel: Sure. For us, fortunately, we're able to treat kind of all stages of osteoarthritis. The most common locations for osteoarthritis is really the hips, knees, shoulders, and those are the places we can absolutely treat. We can treat pretty much almost any joint that you can imagine. In terms of which patients are ideal candidates, the patient would be an older patient. Definitely, we like them older than 50 years old. And earlier the stage of arthritis, the better our outcomes are. Typically, the patients we would not want to treat would be patients that are pregnant, have some type of infection going on in the joint, or it's not osteoarthritis, but other type of arthritis.

Host: So, hips, knees, shoulders, you said are the primary joints that this works best on. So if someone decides to move forward with treatment, what does the process actually look like? How many treatments are involved, and what can they expect during a typical visit?

Dr. Kamal Patel: So, first thing that happens is we'll talk to them, we'll tell them specifically for their situation if we think it can be helpful. We also work in collaboration with their referring physicians, whether that's their primary care physician, their orthopedic surgeon, pain physician, or their sports medicine physician.

In terms of the number of treatments, it would be six treatments over two to three weeks. So, it's typically a treatment that's about every other day. And the treatment itself is very boring. Many of the patients may have already had just a regular X-ray scan, and that's kind of what our treatment looks like. They lay on a table. The treatment takes a few minutes to be delivered. During the actual treatment, they don't really see, feel, or hear anything. And it's about six treatments delivered over two to three weeks.

In terms of pain relief, what the studies show is that pain relief typically begins about three weeks after completion of our treatment, and it keeps getting better and better and better up until about 12 weeks later, at which point it stabilizes and can stay that way for six months, a year, two years, or even longer.

And so, that's what we typically see. Although we have treated patients even during the course of the six treatments where I've seen their pain improve, but that would be the minority of patients. Most patients, their pain will improve after they've finished, about three weeks or so after they've finished.

Host: That is really good news. And when you say people think it's boring, that's a good thing, I think. You know, I think that's really good that they think it's boring. Like you said, they just lay there and it happens. And within three weeks or so, they start feeling the effects of this. So, I think that is really good news. So for someone listening who thinks this might be an option for them, do they need a referral from their physician to get started?

Dr. Kamal Patel: Ideally, that's the pathway we prefer. They would have spoken with either their primary care physician, their orthopedic surgeon, pain physician, or sports medicine physician, occasionally even we get referrals from the rheumatologist and so forth. And that way, we're all collaborating. We're all aligned with the best outcome for that individual.

Host: And then, finally, Dr. Patel, and thank you for your time, what about cost? Is low-dose radiation therapy typically covered by insurance?

Dr. Kamal Patel: Fortunately, most insurances will cover low-dose radiotherapy for osteoarthritis. Our approach here is that we'll see that patient. And then, once the patient says, "Let's move forward," our front staff starts working with their insurance companies to get this treatment approved, and then we have them come back to begin the treatment sequences.

Host: So, pretty straightforward. Dr. Patel, thank you so much for your time. This has really been interesting.

Dr. Kamal Patel: Absolutely, Bill. Thank you so much for your time.

Host: Absolutely. Once again, that is Dr. Kamal Patel. To learn more, please visit eisenhowerhealth.org. And if you found this podcast helpful, please share it on your social channels and be sure to check the entire podcast library for topics of interest to you. This is Living Well with Eisenhower Health. I'm Bill Klaproth. Thanks for listening.