WORKING TO PROMOTE FLYING SAFETY,
AFFORDABILITY, GROWTH AND FUN!!
 Member Login 

 Email Address 


Password

Forgot Password

Flyer Signup
 

A Path to Yes for Cancer Patients

Source: FAA Safety Briefing November/December 2018
By Michael Berry, M.D. - Federal Air Surgeon

Medicine, like any science, is never in a steady state. We are constantly learning, and the state of the art is constantly changing. This change creates friction for those of us in medical certification because regulations and policy tend to be static in nature and certainly slow to change. To alleviate this friction, we routinely evaluate our policies. However, over time, our periodic revisions do not always keep pace with the speed of what is happening in some areas of medicine. We felt such was the case with certain forms of cancer.

Reexamining Cancer

In 2017, we had 1,887 Special Issuances (SI) for airmen suffering from various forms of cancer. In the five-year period between 2013 and 2017, there were a total of only 76 denials for cancer. One reason why this number is so low is because many airmen with cancer do not apply for medical certification, under the assumption that they are not qualified.

In reviewing cancer treatment today, we realized that there were a lot of changes occurring. Cancer is always a tough condition to quantify, because there’s so much variety in this disease. Two different cancers may share little in many aspects besides the name. But what’s promising is that we’ve noticed a significant change in the approach to treatment with certain types of cancer. It used to be that certain cancers were curable, but many, if not most, were an all or nothing affair. If you could shrink it and kill it, or cut it out, you might survive. If you couldn’t, your options were limited to delaying actions to improve the quality of the time you had left.

Today, that is changing. Some types of cancer are now becoming manageable, chronic conditions. This means that while they might not be curable in the classic sense, they are not the existential threat they once were. So how does this affect airman medical certification, if an airman may more likely be managing a cancer?

Finding a Path to Yes

To answer the previous question, we decided to hold a Federal Air Surgeon’s Oncology Summit. We’ve previously used this approach on complex medical issues with great success. The mission of the summit is to find a path to YES, so that more airmen can receive a medical certificate. In order to do that safely, we must not only educate our own policy makers, but also the visiting experts who are helping us. To that end, we scheduled a three-day meeting in early September 2018.

In order to have the best possible insight into the current state of cancer research, we had ten oncology experts join us with specialization in breast, colorectal, and thyroid cancers, in addition to blood malignancies, bone marrow transplants, and pharmacology.

The first day of the summit focused on explaining to our visiting experts how medical certification works. This is important because clinical and regulatory medicine use very different approaches. Our major concern is subtle and sudden incapacitation that would endanger the National Airspace System (NAS) and the environmental challenges a pilot could face. On the second day, our FAA medical experts focused on learning about the latest in cancer research and assessing the risks of both the disease itself and the treatments. The variety within the broad category of different cancers, in addition to the variety of treatment options, meant there was quite a bit of ground to cover.

The final day of the summit was dedicated to both groups of experts working together to see where changes might be made. What cancers could the FAA safely certificate depending on the treatment and prognosis? Could the FAA safely monitor these pilots who were traditionally denied medical certificates? What are reasonable recheck time periods?

These are just a few of the many questions that are on the path to YES. Building that path will improve our ability to make reasonable, risk-based decisions for these airmen. While it’s still a bit too early to share any outcomes or changes, I’m con-fident this summit was a positive step for airmen facing a cancer diagnosis.

Dr. Michael Berry received an M.D. from the University of Texas Southwestern Medical School, and an M.S. in Preventive Medicine from Ohio State University. He is certified by the American Board of Preventive Medicine in Aerospace Medicine. He served as an FAA Senior Aviation Medical Examiner and Vice-President of Preventive and Aerospace Medicine Consultants for 25 years before joining the FAA. He also served as both a U.S. Air Force and NASA flight surgeon.