Dr Ewan Hutchison UK Civil Aviation Authority. ICAO European Regional Civil Aviation Medicine Seminar/Workshop București November 2013

Transcription

1 Dr Ewan Hutchison UK Civil Aviation Authority ICAO European Regional Civil Aviation Medicine Seminar/Workshop București November 2013

2 Types of Cancer Recertification after treatment Certification assessment method Histograms Lymphoid Malignancies

3 Related to gender distribution of population of pilots More male than female private pilots

4 PPL Licence Holders 1/3/ Male Female Age

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6 Commonest reasons for permanent withdrawal of certification: 1) Cardiovascular disease 2) Neuropsychiatric disorder 3) Cancer

7 or The applicant shall not suffer from any disease or disability which could render that applicant likely to become suddenly unable either to operate an aircraft safely or to perform assigned duties safely unable to perform duties safely

8 Part III Chapter 15 Malignant Disease

9 Diagnosis of cancer > TU Assessment for recertification: Specialist medical reports To include information on histology, staging, radiology, tumour markers, treatment, prognosis and follow-up.

10 Remission Full recovery from treatment: Physical and Psychological Assessment of risk of incapacitation from local or distant metastatic recurrence

11 Surgery Radiotherapy Chemotherapy

12 Minor eg skin lesion Intermediate eg prostatectomy Major eg hemicolectomy 1 week 4-6 weeks 2-3 months

13 Curative: intent to cure Adjuvant: to reduce risk of local recurrence Palliative: alleviate symptoms in terminal disease > disqualifying

14 Fatigue, Nausea Dry mouth Diarrhoea Cystitis Permanent effects: lung radiation disease > Ground for minimum of 4 weeks after treatment and until symptoms resolved

15 Short & long term & delayed effects Commonly: neutropenia Anthracyclines: cardiotoxicity Bleomycin: pulmonary fibrosis Vinca alkaloids: neuropathies Minimum of 2 months grounding after completion of course of chemotherapy Minimum of 6 months grounding after anthracyclines

16 Anthracyclines Cardiotoxic evidence of arrythmias & cardiomyopathy arising years after completion of treatment Routine cardiology review may include Ex ECG, Holter & Echo

17 Require evidence from clinical studies about adverse effects of drug & cancer response to treatment Usually not available, so disqualifying Advise pilot to follow advice of treating physician

18 ACCEPTABLE Tamoxifen Goserilin Bicalutamide NOT ACCEPTABLE Steroids

19 Developed by Janvrin factors to consider: 1) Risk of a recurrence 2) Site of the recurrence 3) Risk of a recurrence at that site leading to an incapacitation

20 Risk of incapacitation from recurrence of a tumour in any particular year = Risk of recurrence in that year X Risk of type of metastasis most likely to cause incapacitation X Weighting Factor

21 Data estimated from survival curves Assume survival inversely proportional to recurrence Historical data % survival Years since primary Rx

22 Factors affecting risk of recurrence: 1. STAGE: TNM classification T-tumour size, N-nodes, M- metastases e.g. Stage 1 = T 1 N 0 M 0 2. GRADE: High / Intermediate / Low 3. TREATMENT: Time from completion of treatment [ VARIABLE ]

23 From literature Characteristic sites of recurrence for different types of tumour GI: liver Breast: liver, lung, bone Prostate: bone [ CONSTANT FOR CANCER TYPE ]

24 Based on the likelihood of that recurrence to cause incapacitating symptoms No data, so estimated for each location Consideration of sudden & subtle incapacitation [ CONSTANT FOR EACH LOCATION ]

25 Site Weighting factor % Local 5 Lymph node 5 Liver 5 Lung 5 Bone 5 Bone Marrow 20 Brain 100

26 % Risk Local Liver Bone Brain LN Lung BM

27 Risk of incapacitation from recurrence of a tumour in any particular year = Risk of recurrence in that year X Risk of type of metastasis most likely to cause incapacitation X Weighting Factor

28 20% recurrence risk in first year X 10% risk of cerebral metastasis X 100% weighting factor for cerebral metastasis = 20 x 10 x = 2% risk of incapacitation from cerebral metastases

29 The 1% Rule

30 Survival Survival Survival Stage I Stage II Stage III Years since completion of primary treatment Years since completion of primary treatment Years since comlpetion of primary treatment The numbers on the curves reflect the reduction in survival percentage during each year

31 Number of years since completion of treatment Stage I II III Class 1 Unrestricted Class 1 OML

32 Number of years since completion of treatment T 1 1mm T 2 2mm T 3 4mm T 4 > 4mm N 1 (macroscopic) N 2 (2-3 nodes) N 3 (4+ nodes) M 1 a (skin, subcutaneous) M1 b/c (other metastases) Unrestricted OML No certification

33 Lymphomas & leukaemias Varied patterns of relapse: type, site, clinical presentation Same principles Defer to AMS for evaluation

34 Follow-up reports to AME/AMS to include: symptoms, tumour markers, blood tests, radiological imaging Advise pilot of their duty to inform the NAA s medical department if there is a recurrence

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