Consensus-based recommendation for surveillance of pulmonary problems

This page is part of the PanCare follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for pulmonary problems?

CAYA cancer survivors treated with

  • carmustine (BCNU)
  • lomustine (CCNU)
  • busulfan
  • bleomycin
  • radiotherapy to a volume exposing the lungs, including TBI
  • allogeneic HSCT
  • thoracic surgery

What pulmonary problems might occur?

  • Pulmonary dysfunction
  • Worsening pulmonary fibrosis after high oxygen exposure (such as during anaesthesia) in survivors treated with bleomycin who already have evidence of pulmonary fibrosis

What surveillance modality should be used and at what frequency should it be performed?

  • History with specific attention to pulmonary dysfunction at least every 5 years, starting at entry into long-term follow-up

  • Physical pulmonary exam at least every 5 years, starting at entry into long-term follow-up
  • Pulmonary function tests, including a spirometry and diffusing capacity for carbon monoxide (DLCO), once at entry into long-term follow-up

What other advice should be given?

  • Avoid tobacco, quit smoking and/or reduce exposure to environmental smoke

  • Get a yearly influenza vaccination
  • Pneumococcal vaccination status should be considered by the HCP according to local or national guidelines

What should be done if abnormalities are identified?

  • Repeat the pulmonary function tests if, during subsequent follow-up visits, any abnormalities are identified in the history or pulmonary exam
  • Consult with or refer to a pulmonologist if the pulmonary function tests are abnormal


While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.