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  • Monday, 16 March 2009 15:50
  • Last Updated Tuesday, 06 December 2011 00:33

Commercial air-travel is one of the safest modes of travel and problems specifically related to a patient’s Cancer are rare. However, the environment within the cabin can be challenging; humidity is relatively low and conditions are often noisy and cramped with long periods of sitting. Modern jet aircraft have a cruising altitude approaching 39,000 feet, which is more fuel-efficient and avoids much of the turbulence experienced at lower altitudes. Although cabin pressure is maintained at a more modest 5,000 – 8,000 feet, passengers will be subjected to prolonged periods at reduced atmospheric pressure. The fall in atmospheric pressure has two main effects:

  • A reduction in the pressure of atmospheric oxygen, causing a fall in blood oxygen saturation

  • The expansion of gases in body cavities.

At 8,000 feet the partial pressure of oxygen falls to the equivalent of breathing 15.1% oxygen at sea level. The volume of gas expansion can be in excess of 30%. Most people have the capacity to compensate for such changes with little difficulty. However, for some individuals with an underlying healthcare need, these changes can be problematic. The suitability of flying as a mode transport must be carefully considered if any of the following apply;

  • Oxygen dependent

  • Breathless at rest or on minimal exertion

  • Marked anaemia (haemaglobin < 8 g/dL)

  • Respiratory complaints with a history, or likelihood of, pneumothorax or large bullae

  • Ischaemic heart disease or cardiac failure

  • At risk from, or history of, thromboembolism (NB. Advanced cancer is a highly thrombotic state)

  • Within ten days of receiving bowel surgery or colonoscopy (may introduce gas into the body that may expand so causing pain and stretching the wound)

  • Within 2 - 4 weeks of chest surgery (including drainage of pneumothorax)

  • Up to six weeks following Cranial surgery

  • Disease of the ear or sinuses (symptoms may be exacerbated by pressure changes)

  • Confusion or psychosis

  • At risk of developing cerebral oedema e.g. primary or secondary Intracerebral tumour

The British Thoracic Society recommends that patients planning to fly, who have a resting sea level blood oxygen level of between 92 – 95% with additional risk factors (such as lung cancer, chronic lung or cardiac disease) should undergo hypoxic challenge testing as part of the pre-flight assessment. Patients with a current closed pneumothorax should not travel on commercial aircraft whilst those with a previous pnuemothorax will need a chest x-ray confirming resolution before flight.

Other considerations when flying The airline has a duty of care to all their passengers and will seek to minimise the risk of possible disruption, such as having to make an unscheduled landing to obtain medical treatment. There is neither the skill nor the facilities on commercial aircraft to care for seriously ill people for extended periods of time, and airline staff may refuse to carry passengers whom they feel are too unwell. The AMO will assess the suitability of individuals to travel based on information received from the patient. Further information may be requested from the patient’s GP or cancer specialist. The AMO may only authorise travel when special arrangements are in place with regards to seating, provision of an escort and in-flight oxygen.

Slightly more legroom than standard may be obtained from an aisle seat, which would also give easier opportunity walk around the plane. Some airlines have designated seating for people with disabilities. Seating options can be discussed when booking the flight. If it is likely that the patient will require long periods reclining in their chair or would benefit from additional legroom, then first class travel may be deemed necessary (particularly over longer journeys). The patient will have to meet the additional cost of upgrading. Provision for the patient to travel on a stretcher can often be made but since one stretcher can accommodate the space of up to nine economy class seats, cost may be prohibitive. Flight attendants are trained in first aid and strive to be as helpful as possible, but they are not authorised to give assistance with personal or medical care, or operate medical equipment. In situations where an escort is deemed necessary, the escort must be seated next to the patient. When the escort is a healthcare professional, the patient is expected to meet the costs incurred. The AMO may stipulate that if the patient requires such support, they travel in the company of an escort. The nature of the escort depends on the type of care required e.g
  • A friend or relative acting as a travel companion may suffice if the support needed is for personal care only e.g. feeding, washing, use of the toilet, taking oral medication
  • A trained escort is more likely to be required if care needs are more complex e.g.:
    • if medical equipment is to be used (e.g. syringe driver, nebulizer)
    • when medication needs to be administered by injection
    • there is risk of the patient developing acute episodes which require immediate treatment (e.g. fits, faints)
    • the journey is long and / or involves several transfers between flights.

BT Buddies would like to thank Dr. Simon Noble, Senior Lecturer and Honorary Consultant in Palliative Medicine and Colin Perdue, Clinical Nurse Specialist for granting us permission to reproduce this article.


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