Cancer Care Connections
Cancer Care Connections
Radiation Therapy for Osteoarthritis
Join us for an enlightening conversation with Dr. Jacob Hall, a radiation oncologist at Virginia Oncology Associates (VOA). Dr. Hall is on a mission to bring the technological advances of oncology into the realm of osteoarthritis management to VOA, offering an alternative that provides lasting pain relief without the invasiveness of surgery. Discover how six sessions of low-dose radiation treatment are not only transforming patients' experiences but also enhancing their quality of life by reducing pain.
In this episode, we discuss the process of using radiation therapy across various joints, such as knees, hips, and shoulders, and highlight the profound impact this treatment can have. We also emphasize the importance of personalized care, encouraging you to start your journey with a primary care doctor and explore further resources on Virginia Oncology Associates' website. If you're seeking new avenues for managing osteoarthritis, this episode promises to expand your understanding and inspire hope for those living with joint pain.
Dr. Jacob Hall completed his radiation oncology residency at the University of North Carolina, Chapel Hill. He holds a Bachelor of Science in Aerospace Engineering from Virginia Polytechnic Institute and State University and received his Doctor of Medicine from Virginia Commonwealth University School of Medicine.
Dr. Hall's clinical expertise encompasses a wide range of advanced radiation techniques, including intensity-modulated radiation therapy (IMRT), brachytherapy, stereotactic ablative radiotherapy (SABR), and stereotactic radiosurgery (SRS). He has a special interest in head and neck and central nervous system tumors but is experienced in treating a broad spectrum of cancer diagnoses.
In addition to his clinical skills, Dr. Hall is a productive researcher with peer-reviewed publications focusing on reducing radiation toxicity and improving quality of life. His research interests include integrating advanced radiation techniques with systemic therapies and enhancing cancer care outcomes through innovative treatment approaches. He is also interested in the treatment of benign diseases with radiation, particularly osteoarthritis (OA). He served as the principal investigator for a study investigating OA during his time at the University of North Carolina. He also served on the University of North Carolina Radiation Oncology Research Advisory Committee. His research has been presented at national and international conferences, including the American Society for Radiation Oncology Annual Meeting, the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, and the American Head and Neck Society International Conference on Head and Neck Cancer.
Recognized for his contributions to the field and academic excellence, Dr. Hall was inducted into the Alpha Omega Alpha Medical Honor Society during medical school. He holds memberships in professional organizations such as the American Society for Radiation Oncology and the American Medical Association.
Thank you for listening! If you're interested in hearing more from Virginia Oncology Associates, make sure to subscribe to Cancer Care Connections on Apple Podcasts, Spotify, or anywhere podcasts are available, or listen online at cancercareconnections.buzzsprout.com.
Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at VirginiaCancer.com. or find us on Facebook or Instagram at Virginia Oncology Associates.
Intro: 0:05
Welcome to Cancer Care Connections. On this episode, Cheryl spoke with Dr. Jacob Hall, a radiation oncologist at Virginia Oncology Associates. Dr. Hall discusses the use of radiation treatment outside of cancer, specifically for the treatment of osteoarthritis.
Cheryl: 0:24
Dr. Jacob Hall arrived at Virginia Oncology Associates in 2024. His clinical expertise encompasses a wide range of advanced radiation techniques. He specializes in head, neck, and central nervous system tumors, but also has experience treating a wide range of cancers. He's also interested in the treatment of benign diseases with radiation, specifically osteoarthritis. He served as the principal investigator for a study investigating osteoarthritis during his radiation oncology residency at the University of North Carolina at Chapel Hill. Outside of medicine, Dr. Hall enjoys sports and outdoor activities such as tennis, pickleball, and backpacking with his family. Dr. Hall, thank you so much for joining us today. It's so good to talk with you.
Dr. Hall: 1:13
Yeah, I'd like to thank you for having me. I'm excited to be here and really excited to share this new treatment with the public and hope I can educate everyone and help as we see more patients with this condition.
Cheryl: 1:21
Wonderful, wonderful. Welcome to Hampton Roads. I just wanted to start to get an idea of what brought you to medicine.
Dr. Hall: 1:29
Rewinding, I guess you know 15 years or so, my undergraduate degree is in engineering, actually in aerospace engineering, and that was the original plan. But I wanted to do something that had much more of an individual, meaningful impact on someone's life. Not that you know engineers don't, they certainly do but you're a little more removed from that. But I wasn't willing to give up science and technology and that kind of STEM major. So I started looking around and I found that medicine was really the best combination of those things and still being rooted in science. But you as a physician get to interact with individuals on a daily basis in a very meaningful way.
Dr. Hall: 2:11
And then, kind of moving on to oncology, and radiation oncology specifically, I thought in oncology as a whole, as physicians who work in that specialty, we are privileged to have very meaningful interactions with our patients and develop meaningful longitudinal relationships. And so that really attracted me to the field. And then for radiation oncology, it's something that, compared to some other medical specialties, we use a lot of technology and it's rooted in physics really too. Some other medical specialties are, but radiation oncology even more so. Our patients aren't always aware and our physicists aren't always at the machine, but we actually do have physicists in our field that help us deliver these very complicated treatments to our patients every day, and so I think, them and even our dosimetrists are some of the unsung heroes in our field. So all those things in combination with an engineering background, I thought fit very well for me.
Cheryl: 3:18
Oh yeah, well, I appreciate you sharing that, because I think it's important for our patients to understand the level of training that our specialists have and how much passion you have for the work that you do. So I think it's really really important. As far as what we're talking about today related to osteoarthritis, let's kind of talk about first, what is osteoarthritis? It's clearly not a cancer, but it is something that you're opening up treatment to patients with osteoarthritis at Virginia Oncology Associates.
Dr. Hall: 3:40
Yeah, that's a great question and a great introduction. So osteoarthritis is something I think most people have probably heard of, and if you haven't, or at least know someone who has this condition, it's very common in the United States and globally. It's essentially related to the wear and tear on our joints throughout our body as we age and do physical things or play sports or exercise. This is something that is hard to avoid, but it essentially is stiffness of the joint related to wear and tear and inflammation over time. And that's really, you know, it's a simple diagnosis. This is different from rheumatoid arthritis or other arthritis or inflammatory joint conditions that can be autoimmune in nature or have other causes, so that's a very specific distinction in what we're talking about today. Osteoarthritis is probably the most common arthritis or joint disorder, and so I think that's another reason why it's very important to kind of discuss this, and I'm excited that we're able to offer sort of a new treatment for that.
Cheryl: 4:42
Yeah, I think, as people are hearing what you're saying related to osteoarthritis, they're probably thinking I feel that. I get that. I know somebody who is kind of feeling the aches and pains of, I guess maybe it really is, just getting older. In terms of typical treatment. What is that for osteoarthritis?
Dr. Hall: 5:05
Yeah, so typically we like to start with less invasive and non-medical therapies. Now I don't want to speak too much for our sports medicine or family medicine colleagues or orthopedic surgeons, because they really are the specialists and the experts in this disease, but usually a patient will present to their primary care provider or their family medicine doctor. Treatments for that might involve things that are not drugs or surgery or procedures. So what are those? Exercise and weight loss are really the biggest things,
Dr. Hall: 5:38
physical therapy and we like to start with these things because you're not losing as much and the side effects aren't as severe as some medicines or procedures might be. Then we tend to escalate the treatment if the pain or discomfort doesn't go away. Osteoarthritis is usually more of a chronic or long-term condition that those affected by it will continue to kind of struggle with it throughout their lives. It's a very long disease course. So after those things, we start with basic medical management. That might mean simple over-the-counter pain relief. Aleve is a common brand, Tylenol, a pain medicine that most people have at least tried for something and they have some familiarity with. There could be topical pain relievers as well, and even some alternative therapies that are not standardly used in the mainstream medical community.
Cheryl: 6:29
So, people who are hearing this are thinking, okay, I've done that, I've tried that. I know somebody who has reached for Tylenol or whatever to alleviate pain. Where does radiation therapy come into play as it relates to osteoarthritis? And so somebody hearing this might be like that doesn't necessarily go together in my brain. Um, how does it come together?
Dr. Hall: 6:52
Yeah, that's a good question too, and I think it's a little bit of an open question as well. So just to give you some background on this treatment, radiation for osteoarthritis actually has been around for a long time, for over a hundred years. It has sort of fallen in and out of favor over the past century. In the United States, specifically. In Europe and specifically Germany, it's much more common and they've continued to use it, and it's more commonly used there than even in the United States today. But where this fits in...typically after someone has tried these more conservative, non-invasive measures; physical therapy, weight loss, basic pain relief medications...and one other treatment that we haven't discussed, steroid injections to the affected joint. That's something that we often see in patients who are coming for treatment as well. Part of the reason for this is because of how insurance is able to cover the treatment and radiation for this. This is a standard treatment that is covered by insurance, with the caveat that patients have to have tried two of these other treatments that I've mentioned already. It's not experimental in that sense and it's something that has been offered by insurance companies and in standard guidelines for a long time. But to kind of round out the explanation for why this has fallen in and out of favor, a lot of patients will see that they've been referred to the radiation oncology clinic, who might not have cancer and they're just here for arthritis, and that can be intimidating.
Dr. Hall: 8:28
A lot of patients know someone who has had radiation for cancer and I would like to say that radiation comes in a variety of forms, from very low doses to much higher doses, and it can be an intense treatment for cancer. The radiation that we use for arthritis is a very, very low dose, so that means the side effects are next to zero. And what side effects could a patient expect from this treatment? If you look at the literature, that's something that we tend to do in oncology, in addition to drawing on our own experience,
Dr. Hall: 8:59
but there are papers that report some mild redness in about one in a thousand patients. So that's a very good side-effect profile. Most patients don't have any side effects with this treatment, but I think the reason why it hasn't been as common is just the fear of radiation toxicity in general. As we know it, and as it relates to cancer treatment specifically, that could mean irritation of the skin, or radiation causing cancer. I think over time we've collected more data showing that this treatment is very safe and very well tolerated and that's why, more recently, it's gained a lot of attention.
Cheryl: 9:39
And we have learned too that it is underway now, where it hadn't been before, at Virginia Oncology Associates. Can you talk a little bit more about that? And then, once you do that, we'll talk a little bit more about specific good candidates for treatment for radiation therapy. But talk about the new program underway at Virginia Oncology Associates.
Dr. Hall: 9:58
Yeah, I'm very excited about that.
Dr. Hall: 10:00
So I just joined Virginia Oncology Associates a couple of months ago and in my residency training had the opportunity to lead a trial at the University of North Carolina specifically treating patients with osteoarthritis with this low-dose radiation.
Dr. Hall: 10:15
The trial was called PRO-LO. It was an acronym that just stood for patient-reported outcomes for low-dose radiation and osteoarthritis. Essentially all we were doing was offering this standard treatment in the exact same way it's been offered before, but recording our outcomes and reporting on that in an effort to show and provide evidence from a United States-based academic institution that we feel it's an effective treatment and a safe treatment. I graduated this year from residency and started working at VOA or Virginia Oncology Associates and wanted to bring that with me. You know some of our other radiation oncologists have been in discussion with others about offering this treatment here and we do officially offer this as of recently. We've had the technical capability to do so for a long time, but I think a lot of the discussion was again making sure it's something that we all believe in and believe works and believe is safe for our patients.
Cheryl: 11:12
Wonderful as far as the right person to get this kind of treatment. Can you paint a picture? Can you describe this person? You've talked a little bit about some of the things that a person might be dealing with, but if somebody is listening to this and thinking, okay, am I the right kind of person to get this kind of treatment, what would that look like?
Dr. Hall: 11:34
Yeah, so that person is someone who has a formal diagnosis of osteoarthritis. There are a lot of things that can cause joint pain before we just attribute it to arthritis. So if you're listening to this podcast and wondering if you're a good candidate but don't have that diagnosis, I would encourage you to go see your primary care doctor to establish that and make sure it's not something else going on. But if you do have that diagnosis and have tried multiple more conservative therapies, most commonly that's going to be over-the-counter pain relief, physical therapy, or a steroid injection, then you're someone we would like to see and talk to about this treatment and see if it's something that you'd be willing to do. As far as the age, we generally like to see patients who are older than 50 years old for this, as it's not as common to see people who really struggle with osteoarthritis who are younger than that.
Dr. Hall: 12:23
Anyway, the other thing I'll mention is you can't have had a joint replacement in the joint being treated. So you can have had a joint replacement in other joints, and that's okay. But in terms of the joint we're treating, we don't think that the patients who have had a complete joint replacement would derive benefit from this kind of radiation if they're still struggling with pain there. As far as what joints can we treat with this? Essentially any joint in any of the extremities. We tend not to want to treat the spine, so that's kind of your neck, your mid-back, low back, just because we really do want to minimize radiation dose to all of your important organs inside the body. But we are very confident it's safe to deliver this to the knee, foot, ankle, hip, and really any of the joints in the upper extremity or the arm as well. So we can treat the hand, the elbow, and the shoulder.
Cheryl: 13:18
Can you talk about the way the treatment is delivered? Is it in one setting, two settings? How long does it take? That kind of thing. How we can prepare someone for what they might encounter?
Dr. Hall: 13:30
Exactly, so this treatment is just X-rays. That's the same thing we use for a regular CT scan or a chest X-ray. They're just a higher energy, more powerful version of that, and so this treatment is completely non-invasive in the sense that there's no sedation required. Nothing will break or touch the skin, and patients who receive this treatment will lie usually on their back but will be positioned in a way in relation to the joint we're treating. It'll be usually six sessions of radiation, and those are delivered every other day. So, for example, Monday, Wednesday, and Friday on back-to-back weeks for a very low total dose.
Dr. Hall: 14:10
Now I will say that if you're listening to this and you know someone with cancer who has had roughly that many radiation sessions; five or less sometimes; even though we're delivering six, it's a very low dose each time. So for those other radiation indications for cancer, we can deliver a very high dose in that few number of treatments, but that's a very different treatment, so I don't want you to draw too many comparisons between those things. To summarize, it would be six sessions. You can drive yourself to these treatments because there's no sedation and the treatments are only about 10 or 15 minutes each time. So it's not a not a huge commitment throughout the day.
Cheryl: 14:49
And it's just one set of six sessions, or is it repeated over the course of years or months or anything like that?
Dr. Hall: 14:57
Yeah, that's another good question. So after we complete these six sessions we'll reevaluate roughly at six weeks to a couple months, maybe a little longer, to just kind of assess the response. The reason for that is, compared to pain medicine, for example, where you take the pill and you might feel a little better shortly after you take that pill,
Dr. Hall: 15:18
radiation can take time to work. There are some patients that start to get benefits relatively quickly but it can take a couple of weeks or more for you to see some meaningful benefits. That's why we don't decide if the treatment has really worked as you're getting the radiation or right after. After we decide the treatment has had benefits, we'll continue to see those patients. And if the pain recurs we can talk about treating the joint again, if it's something that the patient's willing to do. If it did not work at all, after we reassess, we actually do still offer a second course because we know in a percentage of patients they will have benefit after receiving that second course, even though they didn't the first time.
Cheryl: 16:03
You mentioned earlier that there are very few side effects of this type of treatment for osteoarthritis, but anything else that a patient or a would-be patient would need to know about this?
Dr. Hall: 16:15
Yeah. So I would say that this is a very well-tolerated treatment and really next to zero side effects. It does not prevent you from receiving other treatments for osteoarthritis for that joint. Meaning, you could still take and do all of the things that you were doing before that may have worked. It doesn't prevent you from getting surgery or a complete joint replacement on that joint. It doesn't add to the surgical risk. It doesn't make it more difficult to get a joint replacement. So, it doesn't really affect anything else that's available to us to treat osteoarthritis for that joint.
Cheryl: 16:54
But when we're talking about quality of life, what is quality of life like for these patients after they've had these radiation treatments?
Dr. Hall: 17:03
Yeah, so really, the goal of this treatment is to improve the pain caused by arthritis and we generally say it works. About two-thirds of patients, or 70 percent or a little more, will have some kind of meaningful improvement in their pain after a single course. That number is a little bit higher if we include those who came back for a second course if it didn't work the first time. The experience is variable, but the majority of patients do have some meaningful improvement, from completely reducing or eradicating the pain so maybe it's not as severe as before. There might still be some, dull underlying pain, but they become more functional and can better use that joint without as much difficulty.
Cheryl: 17:47
You told us earlier about why you decided to come into medicine, and I'd love to hear what it's like when something as simple as this type of treatment is able to help someone live a better life. What is that like?
Dr. Hall: 18:01
Yeah, it's very gratifying, and when it does work, I would say it's one of the more gratifying things that we treat. There's obviously a lot of gratification and pride that comes with curing someone's cancer as well, but quality of life is such an important thing. There are a lot of patients that we've treated that we have seen previously for their cancer and we're now seeing them years after just checking in, and they're doing pretty well. But maybe they mentioned they might have some knee pain or, you know, hip pain, and after we treat that and those that have success with this treatment, they're very happy because it's kind of hard to find good treatments for osteoarthritis. At times, there are a lot of things that work, but over time, you know, the pain tends to come back sometimes, and so, at least in my experience, I think the patients are very happy with deciding to undergo this treatment.
Cheryl: 18:56
It's one of those things that seems like an annoyance and something that maybe people deal with as they get older. But, as you're talking about it, it's one of those things that really does impact a person's day-to-day, so this type of treatment could make a difference. You mentioned earlier about insurance, so I wanted to just sort of talk a little bit more about that. That could be a concern for someone, and they might decide not to do this type of treatment because of the cost. I'd love to hear more about what someone can expect in terms of out-of-pocket costs and that kind of thing related to this radiation therapy.
Dr. Hall: 19:35
So anytime anyone gets radiation; before we actually create and deliver the plan, we have an entire billing department that works with us to make sure their insurance will cover whatever treatment we think is best for that patient. The reason for that is we don't like and do not send patients surprise bills. So assuming someone has tried, as I mentioned before, at least two of the prior non-radiation therapies that don't include a complete joint replacement, they would generally qualify for this treatment by insurance guidelines, meaning most standard insurance companies or Medicare would cover this. Again, just to be sure, we have our billing department run that to make sure that patients don't have a huge out-of-pocket cost after completing this treatment.
Cheryl: 20:24
We know we have patients who listen to this podcast, but there are also may be physicians. If they have a referral that they want to share, what is the process for that?
Dr. Hall: 20:35
Yeah. So I would generally say refer patients to our center, just as they normally would for any other condition or reason that we might see them, is how I would start. You know I'm happy to see any patient if there's a referring provider or physician listening that they think might be a good candidate for this treatment, even just to discuss it with them. I would like to emphasize that we feel this is more of a collaborative approach to this treatment and would be more than happy to discuss really the logistics and how this treatment works with any referring physician, whether it's a primary care doctor or orthopedic surgeon or any other specialist that may have patients that could benefit from this.
Cheryl: 21:20
Where can you suggest people go to get more information about osteoarthritis? And as we were talking about earlier, it could be maybe something they have not gotten a diagnosis for. Maybe it's something someone is dealing with in terms of pain or discomfort, that kind of thing. Where can they go to get more information?
Dr. Hall: 21:42
Yeah. For osteoarthritis specifically as a whole, I would encourage them to first, start by seeing their primary care doctor. But as it relates to radiation for osteoarthritis, there will be a lot of information for patients on our Virginia Oncology Associates website, which is VirginiaCancer.com, and if it's something that someone listening might be interested in, I think the next best place would be to go ahead and refer them to our team. I'd be happy to see them in consultation to really give them the time they need and deserve to answer any questions or concerns they might have about the treatment.
Cheryl: 22:21
Dr. Hall, thank you very much. It was a pleasure talking to you.
Dr. Hall: 22:24
Thank you so much for having me.
Exit: 22:30
That's all for this episode of Cancer Care Connections. On our next episode, Cheryl will sit down with Gina Bright, a nurse with Virginia Oncology Associates. Gina is also an author who has written both fiction and nonfiction books exploring discrimination against certain groups in the healthcare industry. Today, she's going to discuss her perspective of patient care through her personal experiences working in oncology and on an AIDS unit in New York City, as it relates to her novel "The Charon Club".
Don't forget to subscribe to our podcast via Apple Podcast, Spotify or anywhere podcasts are available, or listen online at cancercareconnectionsbuzzsprout.com. Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at VirginiaCancer.com or find us on Facebook or Instagram at Virginia Oncology Associates.