A glioblastoma (GBM) is the most aggressive and common malignant brain tumor in adults. This rapidly growing tumor requires intensive treatment, which impacts a patient’s daily life and ability to travel. Whether a person with glioblastoma can fly is highly conditional, depending on the tumor’s status, recent treatments, and overall health stability. Flying is only possible with mandatory medical clearance from the treating oncologist or neurosurgeon.
Physiological Effects of Cabin Pressure
Commercial aircraft cabins are pressurized to an altitude equivalent of 5,000 to 8,000 feet above sea level, lower than ground level pressure. This reduction in atmospheric pressure presents the greatest risk to a patient with a brain tumor. According to Boyle’s Law, gas expands as external pressure decreases, which can dangerously affect the confined space of the skull.
The expansion of any residual air or gas, such as from recent surgery, can suddenly increase intracranial pressure (ICP), a condition known as tension pneumocephalus. Even without residual air, the tumor and surrounding brain swelling (edema) already contribute to elevated ICP. The lowered cabin pressure can exacerbate this swelling, potentially leading to severe headaches, neurological deficits, or herniation.
The decrease in oxygen saturation within a pressurized cabin, known as hypobaric hypoxia, also poses a threat to patients with existing neurological issues. While healthy people tolerate this environment, lower oxygen levels can worsen symptoms like headaches, dizziness, or confusion in a patient whose brain function is compromised. Hypoxia and pressure changes may also lower the seizure threshold, increasing the risk of an in-flight seizure event.
Factors Related to Recent Treatment
The timing and type of glioblastoma treatment introduce specific, temporary contraindications for air travel. The most significant restriction follows a craniotomy, the surgical procedure to remove the tumor. Flying is advised against for at least four to eight weeks post-surgery due to the risk of air pockets (pneumocephalus) remaining in the skull.
These residual air pockets can expand by as much as 25 to 30% under reduced cabin pressure, creating a dangerous rise in ICP. While some physicians may clear a patient sooner, a computed tomography (CT) scan is often necessary to confirm the air has fully dissolved before flight. The healing of the surgical site and bone flap must also be considered, as pressure changes can stress the recovering tissue.
Patients undergoing radiation therapy may also face a temporary restriction on flying. Radiation can cause transient or delayed swelling of the brain tissue, increasing peritumoral edema. During this phase, the risk of a symptom flare-up due to cabin pressure changes is elevated, and doctors recommend waiting until the acute effects of radiation have subsided.
Systemic treatments like chemotherapy or immunotherapy present different risks, primarily related to the patient’s physical state. Certain chemotherapy agents increase the risk of blood clots, and the prolonged immobility of a flight elevates the chance of developing Deep Vein Thrombosis (DVT). Furthermore, many treatments lead to immunosuppression, making the patient vulnerable to infections in crowded environments like airports and airplanes.
Essential Pre-Flight Planning
Any patient with a glioblastoma must obtain formal medical clearance before booking air travel. This “fitness-to-fly” certificate must be issued by the treating neuro-oncologist or neurosurgeon, confirming the patient is stable enough to manage the physiological stresses of flight. This ensures the doctor has evaluated the patient’s current neurological status, recent imaging, and treatment phase.
Many commercial airlines require passengers with complex medical conditions to submit specific forms for review. This document, often known as a Medical Information Form (MEDIF), provides the airline with details about the patient’s condition, required assistance, and the doctor’s clearance. These forms must be submitted between 48 hours and seven days prior to the flight, allowing the airline time to approve the travel.
Medication management requires careful planning to account for travel delays and time zone changes. Patients should pack all necessary medications, including anti-seizure drugs and steroids, in their carry-on luggage, along with a few extra days’ supply. Carrying a copy of the prescription and a letter from the physician detailing the medications is necessary, especially for controlled substances or injectable drugs.
To minimize physical stress, practical in-flight measures are advisable.
In-Flight Recommendations
- Select an aisle seat for easier movement, which is important for preventing DVT.
- Wear compression socks during the flight.
- Maintain hydration throughout the journey.
- Plan for necessary airport assistance, such as wheelchair services, by notifying the airline in advance.