Cancer

Guidance for medical examiners when assessing a patient for either a general topic or condition – Cancer.

Definition

This guidance should be used for applicants with Cancers other than Lymphoid malignancy, Prostate cancer, Melanoma which are covered in specific advice.

Aeromedical implications

Effect of aviation on condition

  • Hypoxia - lowers seizure threshold and thus risk from cerebral secondaries
  • Fatigue and circadian dysentrainment will tend to aggravate any adverse effects of radiotherapy and chemotherapeutic agents

Effect of condition on aviation

  • Overt incapacitation
    • seizure risk is major hazard
    • haemorrhage
  • Subtle incapacitation
    • biochemical and haematological abnormalities (hypercalcaemia, anaemia etc)
    • pain
    • depression and affective disorders
    • medication side-effects (heart, lungs, liver, kidneys, immune competence).

Effect of treatment on aviation

  • Distraction due to treatment and symptoms eg pain and nausea
  • neutropenic sepsis (neutrophil count less than 0.5 x 109) (1)

Approach to medical certification

Based on the condition

  • Incapacitation risk
  • Absence of symptoms / complications including psychological comorbidity
  • In remission / acceptable staging
  • Acceptable biochemical and haematological parameters

Based on treatment

  • Absence of significant side-effects
    • anthracyclines - cardiac assessment protocol
    • bleomycin etc - respiratory function
    • corticosteroid
    • alkaloids - peripheral neuropathy
    • immunosuppression and anaemia.

Demonstrated stability

  • Stability of treatment and condition confirmed for the period of certification
  • May include interim surveillance

Risk assessment protocol - information required

New cases

  • Confirmed diagnosis
  • History
    • Presentation and course of illness including dates
    • Assessment for co-morbid disease eg depression
  • Clinical status (debility, pain, GI symptoms etc)
  • Grade and stage of malignancy (please include relevant staging investigation reports, scans etc)
  • Management
  • Treatment (types and dates of treatment)
    • Surgery
    • Chemotherapy (curative, adjuvant, palliative) (specify if anthracyclines)
    • Radiotherapy (curative, adjuvant, palliative)
    • Hormone therapy
  • Complications of treatment (note investigations or referrals to other specialists)
  • Follow-up plan
    • Frequency of clinical radiological imaging
    • Frequency of haematological testing
  • Ongoing treatment
    • Description of specific therapy
  • Prognosis and Prognostic factors
  • Risk of possible future recurrence
    • What are the likely clinical presentations of recurrence?
    • Could this be accompanied by incapacitating symptoms?
    • Could a recurrence be detected before symptoms occur by increasing the frequency of radiological, haematological or other surveillance?
  • References to relevant medical literature.

Renewal

  • Confirmed diagnosis (any progression or change to diagnosis)
  • History
  • Clinical status
    • Any evidence of recurrence
    • Any evidence of late stage complications of disease or primary treatment
    • Assessment for comorbid depression / pain / symptoms
  • Management (requirement for any additional treatment since initial primary treatment)
  • Complications of treatment (note investigations or referrals to other specialists)
  • Prognosis
  • Risk of possible future recurrence
    • What are the likely clinical presentations of recurrence?
    • Could this be accompanied by incapacitating symptoms?
    • Could a recurrence be detected before symptoms occur by increasing the frequency of radiological, haematological or other surveillance?
  • Follow-up plan
    • Frequency of clinical radiological imaging
    • Frequency of haematological testing
  • References to relevant medical literature.

Indicative outcomes

  • Primary treatment of the disease should be completed before an assessment can be made of a return to flying or controlling
  • Adverse prognostic factors will normally lead to a longer period before a return to flying and conversely positive prognostic factors will normally lead to a shorter period before a return to flying or controlling
  • A longer time period should normally elapse before returning to flying or controlling after a relapse than is required after primary treatment
  • Anthracycline therapy requires additional period of surveillance and specialist review
  • Common time frames for return to flying and controlling duties:
    • 6 weeks following completion of radiotherapy
    • 2 months following completion of chemotherapy
    • 6 months following completion of anthracycline chemotherapy in addition to satisfactory cardiac assessment.

Favourable

  • Skin basal and squamous cell carcinomas - confirmed histology and fully excised
  • Prostate cancer - see separate guidance
  • Other cancers - successfully treated and in long-term (over 5 years) remission

Unfavourable

  • Metastatic cancers
  • Cancers with an unacceptable risk of cerebral metastases
  • Cancers requiring ongoing radiotherapy or chemotherapy
  • Persisting symptoms / complications
  • >10mg prednisolone or equivalent

Pilot information

  • Any relapse mandates grounding and must be reported to the DAME
  • Any change of treatment mandates grounding and must be reported to the DAME

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

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