Travel: Planning for a holiday

Commercial air travel is one of the safest modes of transport, however flying can pose risks for blood cancer patients.  There may be times when it is better not to fly.  You may not be able to fly if you have had certain treatments, this is because of the changes in pressure or the amount of oxygen in the cabin of a plane.  Always check with your doctor that it is safe for you to fly.  It may be best to avoid flying if you are:

• Oxygen dependent
• Breathless at rest or on minimal exertion
• Anaemic
• Have respiratory complications with a history or risk of developing pneumothorax
• Ischaemic heart disease or cardiac failure
• At risk of thromboembolism
• Thrombocytopenic (Low platelets)

The airport can be a very stressful environment for those with a healthcare need.  At the time of booking you should clarify:

• If it is possible to check in or board the plane early
• The level of assistance with the carrying of luggage or special equipment
• Whether a wheelchair could be made available (and if there is a charge for this service)
• The level of assistance for boarding the aircraft

General dietary advice that is appropriate to all travellers often has particular relevance for those with blood cancer. Food and water can be contaminated in a variety of ways, but risks can be reduced significantly by taking simple precautions:

• If unsure about the cleanliness of piped water supply, boil all water before drinking or cleaning teeth. For additional safety, use only bottled water (ensure that the cap is sealed) – fizzy water is less likely to be tampered with.
• Avoid ice in drinks where cleanliness is in doubt
• Avoid unpasteurised milk
• Eat food that is freshly and thoroughly cooked while still hot
• Avoid food that has been exposed to flies
• If you are following a neutropenic diet the same guidelines apply whether at home or abroad.

Special care should be taken to avoid sunburn, even limited exposure to strong sunlight can cause sunburn and heat exhaustion.  Treatments such as chemotherapy, radiation and immunosuppressants can make you more sensitive to the effects of the sun.

Immunisation against certain diseases may be essential or recommended when travelling to certain countries.  Whether you are able to receive certain vaccines may influence your travel destination.  There are three types of vaccines:

• Live vaccine
• Inactivated vaccine
• Detoxified vaccine

People with blood cancers should avoid live vaccines. Inactivated vaccines and detoxified vaccines are generally safe, however they may be less effective in people with a weakened immunity.    People who have had an allogeneic stem cell transplant will have lost their immunity from previous vaccinations and will require revaccination after completion of their treatment.  It is important to always check with your medical team before having any vaccinations.

It is important to research the medical facilities and the health system in the country you are going to.   The standard of healthcare and its provision varies greatly throughout the world, not only between countries but also within countries.  If your destination is in a remote location, even within a developed country, then healthcare provision may be very basic.   If you are concerned that the country is lacking in suitable medical facilities it may be better to consider an alternative destination that has a better standard of health care.  Information about cancer services within a particular country may be able to be obtained through the relevant high commission, embassy or consulate.

• Take a written summary of your condition that includes:
• Diagnosis
• Recent and ongoing treatment
• Medication
• Contact details (including family members, general practitioner, haematology team and/or palliative care team)

Such written information should be in English and it may need to also be translated into the language of the country you are going to depending on your destination.

There are no restrictions on the carriage of either ‘over the counter’ medications or prescription drugs (not controlled drugs) out of the UK.  However different countries have different laws on drugs that can be brought in to them.

• Keep all medications in original packaging
• Travel with the original prescription and/or a covering letter from the prescribing doctor
• Medication should be secured in a shock proof container and carried in hand luggage
• Carry additional medication to what is considered necessary in case of unforeseen events
• Check with a pharmacist on the availability of a particular medication in the country of destination. It is worth noting that brand names of drugs often differ abroad.
• If the medication needs to be kept cool, utilise a cool bag when travelling and seek confirmation that there is access to a refrigerator at the destination.
• Contact the high commission, embassy or consulate of the country of destination to clarify if there are any restrictions regarding the import of particular medications.

Additional considerations and arrangements must be made if you are travelling with controlled drugs.  The home office stipulates the maximum doses of controlled drugs that an individual may export out of the UK.  If the quantity of controlled drug does not exceed the maximum amount specified, a covering letter from the prescribing doctor should be sufficient to permit the carriage of drug out of, or into, the UK.