On this page you can find:

• Who is at risk for pulmonary problems?
• What pulmonary problems might occur?
• What surveillance modality should be used and at what frequency should it be performed?
• What other advice should be given?
• What should be done if abnormalities are identified?

Who is at risk for pulmonary problems?

CAYA cancer survivors treated with

• radiotherapy to a volume exposing the lungs, including TBI
• allogeneic HSCT
• surgery to the lung or chest wall

What pulmonary problems might occur?

• Pulmonary dysfunction (obstructive abnormalities, restrictive abnormalities, diffusion capacity impairment)

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
• Routine pulmonary function testing is not recommended for asymptomatic at-risk CAYA cancer survivors, due to lack of interventions

to prevent the deterioration of asymptomatic pulmonary dysfunction

What other advice should be given?

In at-risk CAYA cancer survivors:

• Get a yearly influenza vaccination and additional vaccinations based on local or national recommendations
• Consider vaccination against viral pathogens that cause pneumonias according to local or national guidelines

For all CAYA cancer survivors:

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

For all CAYA cancer survivors, based on expert opinion: ^b

• Healthcare providers should be aware of the potential risk of worsening pulmonary fibrosis after general anaesthetic and/or high oxygen exposure (e.g. during scuba diving) in survivors treated with bleomycin
• Survivors treated with pulmotoxic therapies and potentially bleomycin who wish to undertake scuba diving should be assessed by an experienced dive physician before starting to dive

What should be done if abnormalities are identified?

Disclaimer

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.