Oncology guidance material GM

1. Before further consideration is given to their application, applicants with primary or secondary malignant disease shall undergo satisfactory oncological evaluation. Such applicants for a class 1 medical certificate shall be referred to the medical assessor of the licensing authority. Such applicants for a class 2 medical certificate shall be assessed in consultation with the medical assessor of the licensing authority.
2. Applicants with a documented medical history or clinical diagnosis of an intracerebral malignant tumour shall be assessed as unfit.

CLASS 1 - AMC1 MED.B.090

1. Applicants who have been diagnosed with a malignant disease may be assessed as fit provided that:
   1. after primary treatment, there is no evidence of residual malignant disease likely to jeopardise flight safety;
   2. time appropriate to the type of tumour and primary treatment has elapsed;
   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 medical assessor of the licensing authority.
2. An OML should be applied as appropriate.
3. Applicants receiving ongoing chemotherapy or radiation treatment should be assessed as unfit.
4. 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.

CLASS 2 - AMC2 MED.B.090

1. Applicants who have been diagnosed with a malignant disease may be considered for a fit assessment provided that:
   1. after primary treatment, there is no evidence of residual malignant disease likely to jeopardise flight safety;
   2. time appropriate to the type of tumour and primary treatment has elapsed;
   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 jeopardise flight safety;
   5. arrangements for an oncological follow-up have been made for an appropriate period of time.
2. Applicants receiving ongoing chemotherapy or radiation treatment should be assessed as unfit.
3. 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.

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 (PDF).

Note 1: All Class 1 applicants shall be referred to 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).
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 anthracycline (PDF) 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 CAA Medical 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 (PDF) 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 (PDF) exist for these tumour types:

• Colorectal
• Breast cancer
• Malignant melanoma
• Testicular germ cell tumour
• Renal cell carcinoma
• Non-small cell lung cancer

All Class 1 lymphoid malignancies must be referred to the CAA. Guidance material for disorders of the lymphatic system is currently under review.

The above guidance is also available in Ernsting’s Textbook of Aviation Medicine 5th Edition, Chapter 28, Malignant Disease.

UK CAA Guidance on certification after Prostate Cancer (PDF)