Doctors address concerns about air travel safety for patients with brain tumors in this new study.
The global reach of medicine is becoming increasingly easier to achieve. Thanks to the ever-increasing availability of medical information available online as well as the capabilities for long distance tele-health consultations, patients have expanded options to undergo multidisciplinary treatment for their conditions with experts worldwide.
Traveling for neurosurgical care
The field of neurosurgery and brain tumor management is no exception. Patients often will seek second or third opinions at a high-volume brain tumor center of excellence and receive definitive treatment at these facilities effectively giving increased access to those living in cities without experienced teams treating such conditions. This is most relevant to patients in rural areas and those living in countries with limited resources. Hence, traveling for medical treatment (medical tourism) has demonstrated value for the patient opting to receive the best possible care for their condition, while showing financial savings when patients have fewer complications, shorter hospital stays and earlier return to work. This model has been adopted by large health systems and insurers with positive results for complex procedures like heart and transplant surgery.
Is it safe for brain tumor patients to travel by air?
A major question regarding the safety of airflight had, until recently, not been answered, despite the increasing volume of patients with large brain tumors traveling long distances for surgery. In particular, the air pressure changes that occur on high altitude jet airplane flights (which can be equivalent to immediately ascending to an altitude of 8,000-10,000 feet) has been a concern for increasing brain swelling (edema) which could cause major symptoms during flight.
We recently studied this at the Pacific Neuroscience Institute, which is a destination for many patients from national and international locales. In a study recently published in the Journal of Neuro-Oncology, “Safety of commercial airflight in patients with brain tumors: a case series,” (Phillips et.al. 2018), we reported the safety data for these patients.
Overall, airflight was found to be safe for patients with brain tumors.
There was no correlation with brain tumor size or pre-operative symptoms. Of the 41 patients, ten (24.4%) reported new or worsened symptoms during airflight, although most of these symptoms were minor and resolved after landing. Only one patient developed a major symptom (seizure), which was also transient. If patients had no symptoms prior to their flight, none of the patients developed new symptoms during or afterwards.
This publication is the largest study to date assessing the safety of airflight for patients with brain tumors. It is however important to note that this was a relatively small study in terms of sample size and although air flight overall was shown to be safe, one patient with a relatively large benign brain tumor did have an inflight seizure. The patient went on to have a successful surgery and is doing well now with no issues related to his seizure or surgery. This patient’s experience highlights that careful consideration by both doctor and patient are essential prior to allowing a patient to fly for their care at another center.
Specifically, for larger tumors, consideration should be given to preflight and inflight administration of steroids to reduce brain edema and anticonvulsants to reduce seizure risk. In some patients with very large brain tumors already causing cranial pressure, air flight may be considered unsafe and not recommended.
We hope that results from our study will be the impetus for larger studies to be performed to validate this data. Certainly, this study has implications for patient mobility with the goals of improving equal access to quality brain tumor treatment at established centers of excellence.
An everyday question is answered
Since its publication, the article has not only influenced the scientific community, but has also elicited a positive response from the patient community, as many have appreciated a research study that so directly impacts their lives.
Nevertheless, if patients have brain tumors and seek to travel by plane, they should have discussions with their neurosurgeon or neuro-oncologist to ensure individual safety.
Journal of Neuro-oncology, May 17, 2018. Safety of commercial airflight in patients with brain tumors: a case series. Michelle Phillips, MS, Marlon Saria, PhD, RN, Amy Eisenberg MSN, ARNP, CNRN, Daniel F. Kelly, MD & Garni Barkhoudarian, MD.
Garni Barkhoudarian, MD, is a neurosurgeon with a focus on skull base and minimally invasive endoscopic surgery. He has particular interest and expertise in pituitary and parasellar tumors, brain tumors, skull-base tumors, intra-ventricular brain tumors, colloid cysts, trigeminal neuralgia and other vascular compression syndromes. He is an investigator in a number of clinical trials evaluating the efficacy of various medical or chemotherapies for pituitary tumors and malignant brain tumors. For virtually all tumors and intracranial procedures, Dr. Barkhoudarian applies the keyhole concept of minimizing collateral damage to the brain and its supporting structures using advanced neuroimaging and neuro-navigation techniques along with endoscopy to improve targeting and lesion visualization.
Michelle Phillips, MS, is a research assistant at the Pacific Neuroscience Research Center at Pacific Neuroscience Institute. Along with her colleagues in Dr. Santosh Kesari’s neuro-oncology team, she works in the area of clinical trials research to develop potential therapeutic candidates targeting brain cancer.