What You Should Know About Flying With Cancer

Interior Of An Airplane
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Flying on commercial airlines is usually very safe for people with cancer. But If you plan to fly for cancer treatment, or to take that dream vacation, it's important to plan ahead. In addition to allowing extra time to navigate airports and transfer between flights, there are several other considerations to keep in mind.

General Information

The Air Travel Access Act of 1986 prohibits discrimination on domestic flights in the United States on the basis of disability. Despite a few "horror stories" that spread through the news regarding transportation security administration (TSA) agents and "pat downs," TSA agents are ready to assist those with disabilities due to cancer with courtesy and respect. TSA recommends calling their helpline 72 hours before travel to discuss the screening process.

  • You may call TSA Cares at 1-855-787-2227 for information on what to expect at the security checkpoint.
  • You may also request a passenger support specialist.These TSA specialists are trained in assisting people with disabilities of all kinds.

Oral Medications

Carry all medications on board in a carry-on rather than checking them with your luggage. Keep all medications in their original containers. Make sure you have enough medication with you should be delayed a few days on your return. Many insurance companies have a limit on the number of pills you will be prescribed at one time. If this is an issue, talk with your pharmacist. Keep in mind that drug approval varies among countries and that your particular medication may not be available where you are traveling.  It's also important to make sure that your medication is legal in the countries you are visiting.

Traveling With Syringes 

If needed for a medical condition, you may carry syringes and injectable medications on board the plane.  It’s advisable to carry a doctor's letter indicating the necessity of carrying these medications since some checkpoints may require a physician's recommendation.

Getting Around in the Airport

Most airports provide transportation services beyond the security checkpoint. Check with the airports you will be visiting to see what services are available.

Advance Seating

Airlines usually announce advance seating for people with special needs along with first class passengers. If you need assistance with boarding, this option may be helpful. That said, if you are able to move around it may be a good idea to instead move around and board towards the end of boarding, especially if you have a long flight. Prolonged sitting raises the risk of developing lung clots.

Reducing the Risk of Blood Clots

Both air travel and cancer raise the risk of blood clots (deep vein thrombosis and pulmonary embolism) and the risk is higher when the two are combined. Cancer treatments such as surgery and chemotherapy increase the risks further. Thankfully, many of these clots can be prevented by taking a few precautionary measures:

  • Get up and walk around often—at least one time per hour.
  • Exercise your legs while sitting. On overseas flights, it's now common for passengers to be shown a video on leg exercises which may reduce the risk of clots when performed in flight. You can exercise your legs by tightening and then releasing your calf muscles. You can also exercise your legs by lifting your heel repeatedly with your toes on the floor, then lifting your toes several times with your heels on the floor.
  • Choose an aisle seat when possible.
  • Avoid drinking alcohol as it can lead to dehydration and makes platelets (the factors in the blood that cause clotting) stickier.
  • Avoid crossing your legs.
  • Ask your doctor about the use of compression stockings.
  • Talk to your doctor about other measures if you are at a high risk of developing blood clots. She may recommend taking aspirin, or a one-time injection of low molecular weight heparin.

Oxygen Needs at Increased Altitudes

Flying results in a statistically significant decrease in oxygen saturation in the blood. Even though cabins are pressurized on commercial flights, oxygen levels are similar to being at an elevation of 5,000 to 8,000 feet. (Oxygen levels may be lower on small planes.) For those who are healthy, the body accommodates to this lower oxygen saturation quite well. But for those who have compromised lung function due to respiratory ailments, COPD, lung cancer, or lung metastases from other cancers, this can pose a problem.If you suffer from a respiratory condition you may require supplemental oxygen for flying even if you do not require oxygen on the ground. Talk to your doctor before flying. She may be able to make recommendations or offer tests to determine if you will require oxygen in flight.

Estimating Your Need for Oxygen When Flying

For people who have COPD and cancer, or who aren't certain whether oxygen may be required, your doctor may be able to make a prediction based on specific tests. Researchers have developed a pre-flight algorithm that can be used to predict whether or not you may need in-flight oxygen. Since it's been found that people with respiratory disease tend to underestimate their potential need for oxygen when flying, this is a helpful approach for making the decision more objective.

Traveling With Oxygen

Some airlines—but not all—allow portable oxygen to be carried on board the aircraft. According to TSA, if you are able to disconnect from oxygen it's recommended that you check your oxygen as checked baggage. While that is ideal, if you require oxygen when on the ground it's likely that you will require oxygen to even a greater degree while flying.

If you plan on using portable oxygen in flight it's important to call the airline ahead of time to understand any restrictions. It's also necessary to check with the manufacturer of your oxygen concentrator to see if it is approved for flying.

A specific example is the Onboard Medical Oxygen Requirements of Delta Airlines. Delta does allow approved portable oxygen containers with advance notification (but not devices which contain liquid oxygen.)  A physician’s statement must be received by the airline at least 48 hours prior to flying.  Several other restrictions also apply. As airlines differ in their regulations, it is important to check with your airline before flying, leaving plenty of time to find an approved oxygen device if needed, and to receive a doctor’s statement that you require in-flight oxygen.

Air Pressure Changes

Just as scuba divers may experience problems due to air pressure under water, changes in air pressure as a result of the increased elevation in flight can potentially cause problems for some people. It's estimated that gasses in body cavities can expand up to 30 percent.

For this reason, physicians recommend not flying for a period of time after certain procedures. For example, it's advisable not to fly for 10 days after a colonoscopy, 2-4 weeks after chest surgery, and up to 6 weeks after brain surgery. 

After surgery in general, a wait time—usually around 2 weeks—is recommended as the pressure created by changes in altitude could result in incisions breaking open. Talk with your doctor if you have a brain tumor or brain metastases as air travel could create brain swelling. Changes in air pressure can also cause swelling in the hands and feet. People with lymphedema, such as after breast cancer surgery, should talk to their doctors before flying as to recommendations. Overall, wearing loose-fitting clothing and staying well hydrated is important in minimizing discomfort at an increased altitude.

Infection Concerns

If your white blood cell count is low due to chemotherapy or your cancer itself, talk to your doctor about whether or not you should wear a mask. Also, ask her for recommendations about the right mask since some may offer more protection against germs than others. Chemotherapy-induced neutropenia can be a challenge when traveling in many ways.

There are many "hidden" risks of infectious disease, especially when you leave home. Take a moment to learn about ways to reduce your infection risk during chemotherapy whether you plan on traveling or not.

Vaccinations

Vaccinations may be required for travel to certain regions of the world.Talk with your doctor about these recommendations.In some cases, immunizations may be dangerous, for example, if your immune system is compromised. It's important to note that even if immunizations are considered okay, they may be less effective for people undergoing treatment for cancer.

Cancer Fatigue

When you think about your upcoming trip you may picture yourself traveling as you did before cancer. Yet cancer fatigue, whether it is the fatigue the majority of people experience during treatment ​or that annoying fatigue that persists long after treatment is done may leave you exhausted unless you plan for extra rest during your journey. You may find it helpful to write down the activities you wish to take part in at your destination, and then prioritize them as:

  • 1. Something you really want to do
  • 2. Something you would like to do if you have time
  • 3. Something that is optional

If you list out your planned activities in this way you will be more likely to participate in the activities you most wish to do, and will hopefully feel less guilty when you need to take a day or two and just rest.

Travel Insurance

Many airlines, as well as companies such as Expedia and Travelocity, offer travel insurance when you purchase your airline tickets.This is often a small price to pay relative to the cost of your ticket.  Some cover only the cost of your ticket and require a doctor's note.Others offer services in addition to reimbursing your ticket cost, such as emergency medical care at your destination.

Before You Book Your Flight

Once you've figured out whether or not you will need in-flight oxygen there are a few more steps you can take to ensure a successful trip. First of all, if you are traveling for treatment on a tight budget, you may be able to get some assistance. Several organizations provide free air travel for those with cancer who need to travel for medical treatment. 

And keep in mind that oxygen is only one thing to consider before heading to the sky. Check out our list of tips for traveling with cancer to make sure you've covered all of your bases.

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