Oncology GM

Implementing Rules (IRs), Acceptable Means of Compliance (AMCs) and Guidance Material (GM) on oncology conditions

The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the Oncology.

 

 

 

Implementing Rules

Acceptable Means of Compliance

Guidance Material

MED.B.090 Oncology


(a) Applicants shall have no established primary or secondary malignant disease likely to interfere with the safe exercise of the privileges of the applicable licence(s).

(b)  After treatment for malignant disease, applicants shall undergo satisfactory oncological evaluation before a fit assessment can be made. Class 1 applicants shall be referred to the licensing authority. Fitness of class 2 applicants shall be assessed in consultation with the licensing authority.

(c) Applicants with an established history or clinical diagnosis of intracerebral malignant tumour shall be assessed as unfit


Class 1
(a) Applicants who underwent treatment for malignant disease may be assessed as fit by the licensing authority if:
   (1) there is no evidence of residual malignant disease after treatment;
   (2) time appropriate to the type of tumour has elapsed since the end of treatment;
   (3) the risk of inflight incapacitation from a recurrence or metastasis is sufficiently low;
   (4) there is no evidence of short or long-term sequelae from treatment. Special attention should be paid to applicants who have received anthracycline chemotherapy;
   (5) satisfactory oncology follow-up reports are provided to the licensing authority.

(b) A multi-pilot limitation should be applied as appropriate.

(c) Applicants with pre-malignant conditions of the skin may be assessed as fit if treated or excised as necessary and there is regular follow-up.


On reporting a diagnosis of malignancy, applicants should be assessed as unfit.
Recertification can be considered following receipt of a satisfactory specialist report with the information in the 15 point Oncology Request table.
 
Note 1: All Class 1 applicants shall be referred to the AMS.
Note 2: Class 2 applicants shall be discussed with the AMS.
 


For recertification:
Treatment completed
Full recovery
No symptoms that could affect flight safety
No complications, or if any, appropriate investigation and specialist referral may be required

Chemotherapy
1. Recertification a minimum of 6 weeks after the last dose of chemotherapy, subject to satisfactory blood tests results (FBC, U&Es, LFTs, relevant tumour markers as a minimum).




Implementing Rules

Acceptable Means of Compliance

Guidance Material

Class 2
a) Applicants may be assessed as fit after treatment for malignant disease if:
   (1) there is no evidence of residual malignant disease after treatment;
   (2) time appropriate to the type of tumour has elapsed since the end of treatment;
   (3) the risk of in-flight incapacitation from a recurrence or metastasis is sufficiently low;
   (4) there is no evidence of short or long-term sequelae from treatment that may adversely affect flight safety;
   (5) special attention is paid to applicants who have received anthracyline chemotherapy;
   (6) arrangements for an oncological follow-up have been made for an appropriate period of time.

(b) Applicants with pre-malignant conditions of the skin may be assessed as fit if treated or excised as necessary and there is a regular follow-up.

2. If any complications from treatment, need full recovery.  If unresolved, may require appropriate specialist assessment, e.g. neuropathy may require a specialist neurology assessment.

3. Class 1 pilots who have had anthracycline (e.g. doxorubicin, adriamycin, daunorubicin) require cardiological assessment in accordance with the anthracyline flow chart.

Radiotherapy
1. Recertification a minimum of 4 weeks after the last dose of radiotherapy.

2. If any complications from treatment, need full recovery.  If unresolved, appropriate specialist assessment required e.g. radiation pneumonitis/pulmonary fibrosis requires a specialist respiratory assessment.

Surgery
As a guide, minimum post-operative grounding periods:

Minor
e.g. skin lesion
1 Week
Intermediate
e.g. prostatectomy (TURP)
6 weeks
Major
e.g. hemicolectomy
3 months

Metastatic disease
Metastatic disease is disqualifying for Class 1 and Class 2 certification.
In exceptional cases, Class 2 OSL may be considered by the AMS only.

Incapacitation risks are based on:
   1) Risk of a recurrence
   2) Site of the recurrence
   3) Risk of a recurrence at that site
        leading to an incapacitation.

CAA Oncology Certification Charts have been developed based on these medical incapacitation risks: 
   2-5%  per annum Class 2 OSL 
   ≤ 1%  per annum Class 1 OML & Class
   2 unrestricted
   0.1%  per annum Class 1 Unrestricted 
 

UK CAA Oncology Certification Charts exist for these tumour types:  
   Colorectal 
   Breast cancer 
   Malignant melanoma 
   Testicular germ cell tumour 
   Renal cell carcinoma 
   Non-small cell lung cancer

UK CAA Guidance on Lymphoid Malignancies
All Class 1 cases should be referred to the AMS.

The above guidance is also available in Ernsting’s Textbook of Aviation Medicine 4th Edition,  Chapter 44, Malignant Disease.

UK CAA Guidance on certification after Prostate Cancer