Scuba Diving after Bleomycin…With the right precautions


The objective of this post is to add my experience to the growing body of evidence that supports people treated with bleomycin safely returning to scuba diving under the right circumstances.

I was diagnosed with testicular cancer in October of 2005.

I was lucky.  Friends and family supported me during the diagnosis, and I was fortunate enough to live in Vancouver just blocks away from the BC Cancer Agency.   The BCCA is one of the finest clinical care facilities in North America.  3 years after a recurrence that was treated with 3 cycles of BEP (Bleomycin, Etopisode, Cisplatin) chemotherapy in 2007 I feel confident that we’ve beaten it.  I know I have a great number of people to thank, and will remain grateful for as long as I live.

I should note that I’m not a doctor and you should rely on the advice of your physician. 

That said, I’ve returned to scuba diving having obtained the endorsement of my physician and in the past 3 months have enjoyed some of the most thrilling diving of my life.  If you’re a diver and reading this, check out Pescadore Island, Malapascua and Apo Reef.  Whoa.

Getting here involved a great deal of research and talking to people and I’m hoping this post will help people in a similar situation to me.

If you’ve been prescribed bleomycin,  you know that one of its contra-indications is breathing compressed oxygen.  The sheet I was given by my oncologist specifically said that I would not be able to scuba dive again.

Period.

If you read Lance Armstrong’s book “It’s not about the bike” you may remember that there is a point where Lance is prescribed 3 cycles of BEP, but his doctors step in to say they have an alternative series of drugs that would not endanger his lungs, and therefore give him a better chance to return to cycling.  The drug they were avoiding is Bleomycin (the B in BEP).

The Path Back for Divers: Here’s what I found out in a nutshell. You should wait at least 2 years (3 on the most conservative side) post chemo-therapy before considering returning to diving.   You can then complete a pulmonary function test and see a specialist in hyper-baric medicine to present your case and get the go-ahead.

The thing is that even after completing the above with a specialist in hyperbaric medicine, he still felt constrained by the published authorities on the matter.  That’s where it gets frustrating.  After considering my test results and determining that there was no lung injury resulting from my exposure to bleomycin, his review of published research still suggested to him he must take the most conservative approach and support the ban on scuba.

In order to tip the scales, he asked me to get the advice of the Divers Alert Network, (DAN) who are closest to the issue.  If DAN gave the green light, then he would be able to as well.

Here is a thread of the email that I had with the Divers Alert Network DAN, including their contact info if you’d like to approach them too:

Subject: DAN Bleomycin
Date: Tue, 6 Apr 2010 11:56:32 -0400
To: Andrew Gregory

 
Dear Mr. Gregory,

Thank you for your message.

The medication of Bleomycin has been getting more and more attention lately.

Bleomycin may cause pulmonary pneumonitis in about 10% of patients resulting with pulmonary fibrosis in 1% cases. The therapy has many faces and various evolution paths and thus there is no one answer regarding return to diving. The issue has to be discussed with the treating physician who is most familiar with your condition. The final decision will depend on your general condition, i.e. tolerance for exercise, your pulmonary functions and absence of other possible complications that may compromise safety.  And by safely we mean at least the ability to rescue your self and your buddy without hesitation.

It sounds as if you have done everything we would normally recommend in this situation:

PFT, read by a dive medicine physician, approved by a dive medicine physician for diving, and then approval by your treating physician.  The one pre condition being that you are not currently on the medication.

Thank you again for your email and your interest in DAN.

If you have any questions or require further information please do not hesitate to contact DAN.

Have a great day.

Divers Alert Network

Phone:    919-684-2948 ext 238

Toll Free: 800-446-2671 ext 238

Fax:        919-493-3040

________________

Name: andrew gregory

 

RE: Diving after Bleomycin for Cancer Survivors

I am a PADI advanced diver, and cancer survivor who was treated for testicular cancer with 3 cycles of BEP chemotherapy: Bleomycin, Etopiside and Cisplatin.  I completed treatment 3 years ago, and am happy to say that my oncologist has every reason to believe that I am cured.  I return every 4 months for regular checkups.

I have had 3 pulmonary function tests at Vancouver General Hospital and have consulted with specialists in hyperbaric medicine.

The pulmonary function tests results have shown that my lungs were not adversely affected by the exposure to bleomycin.  The doctor has indicated that nothing in my test results would suggest that I should not return to diving.

I have seen varying opinions about whether a person can return to diving after exposure to bleomycin, and under what conditions.  I would greatly appreciate some advice as to whether I can return to diving now that I am over 3 years post chemotherapy and have completed pulmonary function tests that are negative for damage.

I love to dive and the ocean is a passion of mine.

Thank you for your kind attention. Let me know if you require me to become a member of DAN before you can consider my question.

After reviewing this note from DAN, and considering my medical results, the physician was finally able to attest that there is no added risk to me returning to scuba diving than there would be for some other person with the same fitness who had not been treated with bleomycin.

So there you go. If you want to scuba dive, you can.

I’d be very interested to hear any comments from other scuba-divers who have  had this question, who have returned to diving, or who are still wondering if it is safe.   Please feel free to post to this blog if you have any questions.

Post Script: If you or a loved one is diagnosed with testicular cancer, I recommend you do as I did and find the Testicular Cancer Resource Centre (TCRC) and pore through it to prepare yourself to tackle the treatment.   The information, advice and stories there were invaluable to me in getting my mind right and gaining a sense of control.

More Resources:

Here’s another citation I came across after the fact.  More and more are being written each month which leads me to believe that the outright ban on diving will soon be a thing of history:

“…We strongly believe that resuming scuba diving 6—12 months after an uncomplicated series of three or four cycles of BEP is completely acceptable. Caution should only remain for patients who develop clinical signs of pulmonary-function impairment during or shortly after bleomycin treatment. We deem the conservative opinions of many physicians and diving organisations about recreational diving after bleomycin treatment as unnecessary—opinions that we hope to change. Young men affected by testicular cancer should be able to undertake their normal daily life as fully as possibly after treatment with bleomycin.”

The Lancet Oncology, Volume 8, Issue 11, Pages 954 – 955, November 2007 – Bleomycin and scuba diving: where is the harm?

Original Text Ronald de Wit a, Stefan Sleijfer a, Stan B Kaye b, Alan Horwich b, Ben Mead c, Dirk T Sleijfer d, Gerrit Stoter a

6 thoughts on “Scuba Diving after Bleomycin…With the right precautions

  1. Is there a limit to the depth you can dive? I was a TDI instructor (Extended Range) and did most of my diving between 30m – 55m on air with Nitrox as a decompression gas (usually around 80% O2). I only recieved 2 treatments of Bleo (I had a reaction to the drug) in 2007 and if i was to return to diving i would want to return to deep diving, is that possible from your research or is it all fish and coral from now on?

    1. Hi Aaron,

      I was told by the specialist that there was no limit to depth, but I was referring to 40m, not 50. My expectation is that once you have had your lungs tested they will be able to tell you any limitations you face…but I can’t advise you personally. Go ahead and pursue the question with specialists locally. I’d be interested in learning what you find out. Good luck.

  2. I finished my treatment for hodgkins lymphoma 6 months ago. Treat is abed with the bleomycin of 240 mg. I am a commercial diver and was never told of the possibilities of problems with bleomycin. So, I have been diving shallow the whole time (less than 30 feet). I am now set to take a diving vacation. Does anyone have experience using nitrox -32 mix?

    1. Hey Dan,

      Sorry, I spaced on this comment for a while. Have you been on the vacation yet?

      It’s surprising that you weren’t told that there was any issue with scuba diving. It could mean either that the ban has been removed, or that the amount that you were exposed to did not warrant a mention.

      I recommend that you raise the issue with your oncologist and ask what his advice is. As I mentioned in my post I dove over a dozen times in Asia over the past year and it was some of the most exciting diving of my life.

      As for the Nitrox…I don’t know enough about it to have an opinion. Contact a specialist in hyperbaric medicine. When I was in Malapascua lots of people were on Nitrox as one of the most popular site is a manta ray cleaning station at depth where Threshers are expected to cruise.

      Let me know what you find out, and enjoy the diving!

  3. Andrew,

    I was also diagnosed with testicular cancer arround the same time you were. My Oncologist never told me not to dive again so in August i went on a cruize with my wife for our aniversary. So i went diving in Grand cayman. (Devils grotto 30ft @ 40 minutes and another dive, Blackies hole 30 minutes at 80ft.) it was an amazing dive best one i have ever had a chance to go on, and no problems at all. Now i’m having a tumor that they have been monitoring removed(hasnt grown since for 5 years). and now the urologist is freaking out and telling me i shouldnt ever dive again. My goal was to get out of the military in 3 years and go to the commercial dive school in seattle. At first his comments Crushed me. but now they only make me angry and confused. this topic is so confusing and under studied by doctors it is frustrating.

    1. Congratulations on your Grand Cayman dive! Sounds fantastic.

      Several things about your situation are maddening. First that your original oncologist didn’t say anything about the prohibition on compressed air . This is bordering on malpractice. Second that it should be so incredibly difficult to get a reasoned appraisal of the actual dangers of scuba diving for people like us.

      Don’t let it get you down though. I recommend you follow the steps I outlined in the blog post and once you are cleared make your own informed decision. I’d recommend you share the post with your urologist as well. He should be able to run down the best next steps for you.

      Hope everything works out, and don’t hesitate to get in touch if I can help.

Leave a Reply to Josh Cancel reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s