When Dr. Michael Steinberg, a Santa Monica radiation oncologist, begins to discuss a radiation therapy schedule with a cancer patient, he sometimes fields questions about travel too. It's not uncommon, he said, to hear a patient say: "I have a cruise scheduled in seven weeks. Can I go?"
The answer, according to Steinberg and other experts, must be decided on a case-by-case basis for cancer patients, as well as those with chronic conditions such as severe asthma or AIDS. But in general, physicians say they are more open-minded than ever about approving travel for patients with these health problems, especially if the trip is to see family members or to fulfill a lifelong wish to visit a particular place. A few caveats:
Patients should choose a destination with the lowest possible disease risk, close to excellent medical facilities, and follow guidelines about immunizations and other measures recommended by the federal Centers for Disease Control and Prevention.
Some patients feel good enough to go on vacation even a week or two after completing radiation therapy, said Steinberg, who is also a UCLA clinical professor of radiation oncology. Combination treatment with both chemotherapy and radiation generally takes longer to bounce back from. "I recommend patients wait three to six weeks after treatment if they have both radiation and chemo," he said. And for patients whose cancer was in more advanced stages at the time of diagnosis, feeling better could take even longer, Steinberg said.
Dr. Terri Rock, a Santa Monica family practice physician with expertise in travel medicine, often sees patients after they have been cleared for travel by their oncologist. If they are determined to go to an exotic locale, she advises them to choose the one with the least risk for such diseases as malaria.
Rock also advises choosing destinations that do not require administration of live vaccines, which are not recommended for persons with compromised immune systems, including those who have recently finished chemotherapy.
Patients with asthma should not travel, Rock said, if they are not "well controlled." She considers patients well controlled if they rarely need to use their "rescue" inhalers and if they have not recently needed emergency care for their symptoms. She said exposure to potential asthma-triggering situations is great during travel.
For travelers with AIDS, the CDC offers a host of recommendations. Toting portable water filtration units is advised for trips to developing countries, in case it is not practical to boil water. Taking along an antimicrobial drug such as ciprofloxacin is advised for all HIV-positive travelers destined for developing countries, in case traveler's diarrhea occurs. Avoiding live vaccines (except measles in nonimmune persons) is recommended.
It's wise to take along copies of prescriptions, said Lee Klosinski, director of education for AIDS Project Los Angeles. It's not unusual, he said, for an HIV-positive person to take 40 pills a day. Such a large supply could arouse suspicion at border checkpoints, he said, and replacing lost or stolen pills without a prescription would be daunting.
In her work leading support groups for cancer patient, Janet Kraemer, program director at the Wellness Community-Foothills in Pasadena, has heard participants say that the less structured the trip, the better. With fewer events scheduled, patients tell her, they don't have to feel bad about taking time off to rest.
Healthy Traveler appears the second and fourth week of every month.