Post-Radiation: Travel Or Rest?

Travelling after radiation treatment can be fun and fulfilling, but there are a few things to consider if you're planning a trip abroad. Firstly, it's important to check whether you're fit to travel. Your doctor can advise you on any potential risks and whether it's safe for you to fly. Some treatments can cause short-term physical issues, such as increased sensitivity to the sun, which may impact the activities you can do while abroad. It's also important to consider the practicalities, such as whether you'll need a travel companion or any special equipment.

Another key consideration is travel insurance. Having cancer or being in treatment can affect your ability to get insured, and recent health problems are considered pre-existing conditions by insurers. They will assess your personal information to estimate the likelihood of you needing to cancel your trip and the potential cost of treatment abroad. It's crucial to be open about your health and seek guidance from travel insurance providers, as their approach may vary.

Overall, travelling after radiation treatment is possible, but careful planning is necessary to ensure a safe and enjoyable trip.

Oxygen levels and pressure changes during flight

Flying can be challenging for anyone, but it can be especially difficult for people who have recently undergone medical treatment. The pressurised cabin environment of a plane is very different from what our bodies are used to, with lower oxygen levels, extremely low humidity, and sudden changes in air pressure.

Oxygen levels

The air at high altitudes has lower oxygen levels than the air at ground level. Therefore, planes must pump compressed, cooled, filtered air into the cabin to ensure there is enough oxygen for passengers to breathe. However, the amount of oxygen present in the cabin is still lower than what we are used to at sea level. This can cause fatigue and reduced mental sharpness, even for healthy individuals. For people with heart or lung conditions, the reduced oxygen levels can be even more problematic and may require the use of an oxygen concentrator during the flight.

Pressure changes

As the aircraft climbs to its cruising altitude, the ambient pressure in the cabin decreases, causing any gas inside the body to increase in volume by approximately 30%. This can lead to problems if gas becomes trapped and unable to expand freely, particularly for people with upper respiratory tract infections or recent surgery. During the descent, the increasing cabin pressure will lead to a corresponding reduction in volume, which can cause ear or sinus pain and even bleeding.

Practical considerations for air travel after radiation treatment

If you are considering air travel after radiation treatment, it is important to consult with your doctor to ensure it is safe for you to fly. They may recommend that you avoid flying if you have very low levels of platelets or red blood cells, as this can increase your risk of bleeding and make breathing more difficult due to reduced oxygen transport in the blood. Your doctor can advise you on whether you need to have oxygen during the flight and can help you arrange this with the airline. It is important to contact the airline as soon as possible, as this process can take some time. Additionally, your doctor may recommend that you take aspirin and wear compression stockings during the flight to improve blood flow and reduce the risk of blood clots.

Blood clot risks

People who have or have had cancer are at a higher risk of getting a blood clot in a vein, a condition known as deep vein thrombosis (DVT). This is a serious health problem that can lead to death if left untreated. DVT usually forms in the lower leg, thigh, or pelvis, but it can also occur in the arm. In some cases, DVT can break off and travel to the lungs, resulting in a pulmonary embolism (PE).

Cancer patients, particularly those undergoing chemotherapy, have a significantly higher risk of developing DVT compared to the general population. Patients with brain, pancreatic, stomach, and lung cancers are at the highest risk.

There are several factors that can increase the risk of DVT in cancer patients:

• Injury to a vein during major surgery
• Slow blood flow, which can be caused by staying in bed for extended periods
• Having a catheter in a central vein—up to half of cancer patients with a central venous catheter for long-term chemotherapy develop DVT
• Low platelet counts due to cancer treatment

To lower the risk of DVT, it is recommended to:

• Consult with your doctor about taking anticoagulants or blood thinners before surgery or catheter placement
• Wear compression stockings to improve blood flow in the legs

It is important to be aware of the symptoms of DVT, as about half of those affected may not experience any signs. The most common symptoms include:

• Pain or tenderness not caused by injury
• Skin that is warm to the touch
• Skin redness or discolouration

If you experience any of these symptoms, it is crucial to seek medical advice immediately.

In addition, radiation treatment for cancer can lead to a condition known as radiation-induced vasculopathy, which causes narrowing of blood vessels (lesions) and reduces blood flow. This condition mainly affects the brain and can result in headaches due to limited blood flow (ischemia). Ischemia can further lead to ischemic stroke or transient ischemic attacks (TIA). Radiation-induced vasculopathy can also cause sudden bleeding in the brain, known as a hemorrhagic stroke.

The risk of radiation-induced vasculopathy is higher in patients who have undergone radiation treatment, especially at a young age. Symptoms typically appear six to eight years after radiation therapy. Diagnosis involves a physical exam, medical history review, and imaging tests such as MRI and CT angiography. Treatment depends on the severity and may include medications to relax blood vessels and improve blood flow, such as aspirin.

Travel insurance

People with cancer can often struggle to find travel insurance and if it is available, it is often more expensive than cover for someone without a pre-existing medical condition. This is because insurers deem those with pre-existing conditions to be more likely to make a claim. Some mainstream insurers will agree to insure your trip but will exclude cover for any claim related to cancer. If you would prefer a more comprehensive policy, a number of specialist firms insure people with pre-existing medical conditions, including cancer. You should, however, be prepared to pay a higher premium because of the greater risk of a claim.

When taking out travel insurance as someone with cancer, you will likely have to answer questions about your diagnosis, the stage and grade of your illness, as well as the prognosis. The insurer will also probably ask for a letter from your doctor to confirm that you are fit enough to travel. The premiums will vary according to the severity of the cancer and the stage of treatment.

• The cost of travel insurance for cancer patients can depend on where you are travelling to.
• If your cancer changes, be sure to let your insurance provider know as soon as possible. In some cases, you may be asked to pay an extra premium to cover changes, plus an admin fee.
• If your cancer is undiagnosed, you may still be able to travel with insurance, but you won't be covered for any claims related to your undiagnosed condition.
• If you are taking cancer medication abroad, it's best to ask your doctor or pharmacist whether your medicine contains a controlled drug. If it does, reach out to the embassy or High Commission of your destination country for advice.

Vaccinations

• Consult Your Healthcare Team: Before making any travel plans, discuss your intentions with your healthcare team, including your doctor and any specialists involved in your treatment. They can advise you on whether it is safe for you to travel and any precautions you need to take. This is especially important if you've had lymph nodes removed, as air travel can increase your risk of lymphedema.
• Timing of Travel: It is recommended to start slow and close to home after radiation treatment. Consider a night or a weekend away, somewhere fairly close, and gradually increase your travel distances and duration.
• Vaccination Requirements: Different countries have varying vaccination requirements for entry. Consult your healthcare team and official travel advice for your intended destination to determine which vaccinations are necessary. Some cancer treatments can interfere with certain vaccinations, so it is crucial to seek advice from your healthcare team before proceeding.
• Vaccination Timing: Plan your vaccinations in advance, as some vaccines require multiple doses and take time to become effective. It is recommended to make an appointment with your healthcare provider or a travel health specialist at least one month before your intended travel date.
• Revaccination: Cancer treatments may affect your previous vaccinations. Talk to your healthcare team to determine if you need to be revaccinated for diseases you were vaccinated against in the past.
• Malaria Prophylaxis: If you are travelling to a malaria-endemic area, consult your healthcare provider about appropriate antimalarial medications. Start taking the recommended medication before travel, during your stay, and continue after returning, as directed by your healthcare provider.
• Sun Sensitivity: Radiation treatment can make your skin more sensitive to the sun. If you are travelling to a sunny location, take extra precautions such as wearing protective clothing, using sunscreen with a high SPF, and seeking shade during peak sunlight hours.
• Travel Insurance: Ensure you have adequate travel insurance that covers any pre-existing medical conditions, including cancer. Be honest about your health history when obtaining travel insurance, as failing to disclose relevant information may result in a lack of coverage.

Medication and medical equipment

Travelling abroad after radiation treatment may require you to take certain medications and medical equipment with you. Here are some essential considerations:

Medications:

• Ensure you have enough medication for your entire trip, plus some extra in case of delays. Keep them in their original, labelled containers, and clearly label them with your name, your doctor's name, the generic and brand names, and the exact dosage.
• For injectable medications, you may need a letter from your doctor that verifies its use.
• Some medications are sensitive to high temperatures and humidity, so store them properly during travel and after arriving at your destination.
• If you are travelling with controlled substances or injectable medications, ask your prescribing healthcare provider for a note.
• If you are travelling with syringes, separate your used and unused ones, and carry them in a safe and secure case to prevent accidents.
• If you are travelling with pre-loaded syringes, ensure each syringe is clearly labelled so that the contents can be easily identified.
• Check the regulations of your destination country regarding medications. Some countries may require a prescription or medical certificate for certain drugs.
• If your medication is not allowed at your destination, consult your healthcare provider about alternatives, and have them write a letter explaining your condition and treatment plan.
• If you are travelling to a different time zone, consult your healthcare provider about any adjustments to your medication schedule.
• If you are travelling for more than 30 days, discuss with your healthcare provider how you can obtain enough medication for your trip.

Medical Equipment:

• If you need oxygen support, arrange this with the airline in advance.
• If you have lymphedema issues, consult your doctor about wearing a compression sleeve during air travel.
• If your therapy involves implanted radiation seeds, ask your doctor for a special card to facilitate your passage through airport security.
• If you have electronic medical devices, such as insulin pumps, pacemakers, or implantable cardioverter defibrillators (ICDs), consult the manufacturer to confirm if your device can safely pass through airport security screening machines.
• Always carry a medical alert bracelet or necklace that provides essential information about your health condition(s).

Frequently asked questions