title: To dive or not to dive with bleomycin: a practical algorithm.
abstract: BACKGROUND
  Bleomycin is used in the treatment of different cancers, but possible side effects of interstitial pneumonitis and fibrosis are associated with increased concentrations of oxygen. Therefore, clinicians are reluctant to declare young people fit for scuba diving after bleomycin treatment, because scuba divers might be exposed to high partial pressures of oxygen.
  
  
  METHODS
  Based on a survey, 16 patients treated with bleomycin for either testicular/germ cell cancer or Hodgkin's disease were evaluated according to an algorithm to assess their fitness to dive. The algorithm is based on a review of the literature related to oncology, anesthesiology, and diving medicine.
  
  
  RESULTS
  According to our protocol, 12 of the 16 patients were fit for scuba diving. However, the two groups of cancer patients showed considerable difference with regard to fitness for diving, i.e., 10 of 11 patients with testicular/germ cell cancer compared with 2 of 5 patients with Hodgkin's disease.
  
  
  CONCLUSIONS
  The algorithm can be used by physicians and diving organizations to assess fitness for scuba diving after bleomycin treatment. However, patients with Hodgkin's disease treated with a combination of bleomycin and radiation may be at higher risk of radiation-induced pulmonary problems and are therefore more likely to be unfit for scuba diving.
authors.affiliation: Maritime Medical Expertise Center, Royal Netherlands Navy, Den Helder, The Netherlands. ravhulst@planet.nl
authors.forename: Robert A
authors.initials: RA
authors.lastname: van Hulst
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Rietbroek
authors.forename: Menno T W
authors.initials: MT
authors.lastname: Gaastra
authors.forename: Noel J J
authors.initials: NJ
authors.lastname: Schlösser
mesh_terms: D000328:Adult; D000465:Algorithms; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D001761:Bleomycin / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000009:adverse effects; D004242:Diving / Q000502:physiology*; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D008168:Lung / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D013736:Testicular Neoplasms / Q000188:drug therapy; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D001761:Bleomycin