Basic Med Lymphocytic Leukemia and Prostate Cancer

[Basic Med Question]

Have been on basic med for years. Looks like I now have both of the above conditions. Was under the impression since I've been basic med since it became available, that only cardiac, neurologic issues, stroke would be disqualifying. Am I mis-interpreting?

 

[Half Fast]

I don't think you're misinterpreting; leukemia and prostate cancer are not on the list of conditions requiring a one-time SI. Of course, treatments may require you to ground yourself temporarily. For now, focus on treament and recovery. Flying can wait a little while.

 

[bbchien]

I don't think you're misinterpreting; leukemia and prostate cancer are not on the list of conditions requiring a one-time SI. Of course, treatments may require you to ground yourself temporarily. For now, focus on treament and recovery. Flying can wait a little while.

THIS!
B

 

[geezer]

Grounding yourself is critical to keep this category of flying in existence. All the rest of the pilots will appreciate your action, even if they never know who you are.

The FAA can too easily suspend this benefit if borderline pilots keep flying until they fail in the air.

 

[Clip4]

Have been on basic med for years. Looks like I now have both of the above conditions. Was under the impression since I've been basic med since it became available, that only cardiac, neurologic issues, stroke would be disqualifying. Am I mis-interpreting?

Maybe I am a bit confused here, but part of the pilot self assessment you are supposed to be doing preflight includes illness, medications, stress and emotional.

So unless you are really happy being diagnosed with 2 cancers, forgoing medications and not suffering any emotional or stress issues with this diagnosis, you are not airworthy. And I am saying this not to be cruel, but as a cancer survivor myself.

 

[Mark K]

The problem with both CLL and prostate cancer is that the severity of those conditions can vary all the way from no symptoms and monitoring to active treatment for both. If you are recently diagnosed and have active treatment ongoing, then self grounding is likely indicated. Even if you're not getting active treatment, if the diagnoses are recent you may want to self ground until you've had some time to process the diagnoses and figure out your game plan.

On the other hand, if both conditions are stable with no active treatment planned, just periodic monitoring/surveillance, then I'd just ask your doctors if there are any reasons why you should self ground and see what they think. If your stable, no active treatment, no new/prohibited meds and otherwise mentally and physically feel well, it's my understanding you could fly continue to fly under BasicMed.

 

[Brad Z]

14 CFR 61.53(b) always applies. Discuss with your doctors and self-ground as necessary…

“[…, a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.”

 

[Kenny Phillips]

Certainly get genetic testing, as there can be a genetic component for both of those diseases (though both my brother and I have had RALRP surgery in the last year, for PCa, but we do not have the BRCA gene mutations.)

 

[Mark K]

for CLL, there is a standard set of genetic tests that are typically done. For prostate cancer the current medical answer is, "sometimes." So that's one to discuss with your urologist/oncologist to see if you fall into any of the categories that would benefit from genetic testing as you may or may not need genetic testing if you develop prostate cancer.

 

[Kenny Phillips]

for CLL, there is a standard set of genetic tests that are typically done. For prostate cancer the current medical answer is, "sometimes." So that's one to discuss with your urologist/oncologist to see if you fall into any of the categories that would benefit from genetic testing as you may or may not need genetic testing if you develop prostate cancer.

I recommend genetic testing for any cancer; it can help further research. It's known the BRCA mutations affect both male and female reproductive organs, for example. But to see if there is another vector that increases the chances of a given cancer is useful information. (Of course, it can lead to anxiety, if you've got some mutation but no symptoms, yet. I'm a carrier for a nasty disease that is thankfully recessive, but extremely uncommon in the USA, so it would have been unlikely to manifest in offspring. Vastly more common in Japan, however.)

 

[WDD]

Great that you are taking the responsibility to ask smart questions. As mentioned above, take care of your health first.

To your question. If you get treatment, does that treatment have side effects that interfere with your ability to do the things to fly safely? For example, you get nausea for the first few days after a monthly treatment but are fine after that? Is there a chance the nausea could pop up unexpectedly?

Does the cancer itself cause side effects, such as headaches, fatigue, etc.?

Net net, I would think that you and your doctor are the ones that know best on what might or might not cause a lowering of your mental and physical abilities to operate an aircraft.

 

[Mikey52]

I recommend genetic testing for any cancer; it can help further research. It's known the BRCA mutations affect both male and female reproductive organs, for example. But to see if there is another vector that increases the chances of a given cancer is useful information. (Of course, it can lead to anxiety, if you've got some mutation but no symptoms, yet. I'm a carrier for a nasty disease that is thankfully recessive, but extremely uncommon in the USA, so it would have been unlikely to manifest in offspring. Vastly more common in Japan, however.)

What would be the insurance hit from the genetic testing results?

 

[flyingron]

Grounding yourself is critical to keep this category of flying in existence. All the rest of the pilots will appreciate your action, even if they never know who you are.

The FAA can too easily suspend this benefit if borderline pilots keep flying until they fail in the air.

I believe RonW and I have both done independent studies that show that the self-assessing medical certificate holders don't tend to have any better outcomes in sudden incapacitiation situations than self-assessing non-medically certified ones. The problem however, is that it's such an infrequent case, that it's hard to get meaningful stats.

 

[Clip4]

What would be the insurance hit from the genetic testing results?

If you are addressing cost, you will likely find the labs offer a very affordable cash deal for those with insurance that doesn’t cover these tests. From a coverage perspective, there is no preexisting conditions exclusion in ACA plans.

What these test do, particularly for prostate cancer, is provide a valid indication of the aggressiveness of the cancer based on genomics vs cell appearance of Gleason scoring. There are higher grades of prostate cancer that do score low risk of metastasis and others that score very high. The care team can then recommend treatment accordingly that may preclude getting unneeded treatments or even just surveillance,

 

[Dwayne]

14 CFR 61.53(b) always applies. Discuss with your doctors and self-ground as necessary…

“[…, a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.”

!!!

 

[Kenny Phillips]

What would be the insurance hit from the genetic testing results?

In general, under the ACA, we share the burden, which is why some rates have gone up 500%.
In the case of my gene, it would only have affected my children, and then only if I had produced same with an afflicted female.
But BRCA gene mutations are worth knowing about, period, the end, regardless of what is done to rates. You can get private testing if you want, but then you'd need to see the doc anyway, so ... no escape.

 

[Basic Med Question]

I'm the original poster. The lymphocytic leukemia (CLL) is not at a level requiring treatment yet according to MD Anderson. Had 12 prostate biopsies 8-9 months ago that were clean for prostate cancer ... in the course of workup with the recent CLL, PET/CT scan detected a possible "new mass" and MRI confirmed it (awaiting biopsy) which was 8 months after those original biopsies.

To one of the other replies: Have not been flying and wouldn't fly if feeling poor. Currently no treatments pending new prostate biopsy and would definitely self ground if under treatment (I saw a message regarding chemo from Dr Chien to another pilot here on this forum warning to make sure they're ok prior to flight).

 

[Mark K]

As far as getting medical tests of lesser but nonzero value (ie many cases of prostate CA, for instance).

Let me reformat into an aviation analogy.

How about I argue instead of an annual, we have every six months evals. Sure, twice the cost, but it's got to be helpful, right? More is better, always. Of course. I mean we'll find something earlier. If even one life is saved...

Docs spend a lot of time and research trying to figure out what tests are worthwhile and what tests just waste valuable health care resources. From a public health care policy standpoint, health care dollars are limited. Genetic tests tend to be costly. If they provide little to no value to the patient, and, outside of a research study (in which case, usually the research study picks up the tab), they just take away health care dollars from something more medically useful.

I mean, you all can't have your genetic testing and Ozempic without everyone's premium going way up unless you stop paying for all that prenatal care...

 

[Kenny Phillips]

As far as getting medical tests of lesser but nonzero value (ie many cases of prostate CA, for instance).

Let me reformat into an aviation analogy.

How about I argue instead of an annual, we have every six months evals. Sure, twice the cost, but it's got to be helpful, right? More is better, always. Of course. I mean we'll find something earlier. If even one life is saved...

Docs spend a lot of time and research trying to figure out what tests are worthwhile and what tests just waste valuable health care resources. From a public health care policy standpoint, health care dollars are limited. Genetic tests tend to be costly. If they provide little to no value to the patient, and, outside of a research study (in which case, usually the research study picks up the tab), they just take away health care dollars from something more medically useful.

I mean, you all can't have your genetic testing and Ozempic without everyone's premium going way up unless you stop paying for all that prenatal care...

Genetic tests are actually quite affordable, BTW. I paid for some, insurance for some, the NIH for some, depending on who wanted what.
Easily the most bang per buck (though PSA is very cheap for PCa) for knowing what to watch for in the future. You only need to do it once, remember.

 

[AvNavCom]

Docs spend a lot of time and research trying to figure out what tests are worthwhile and what tests just waste valuable health care resources. From a public health care policy standpoint, health care dollars are limited. Genetic tests tend to be costly. If they provide little to no value to the patient, and, outside of a research study (in which case, usually the research study picks up the tab), they just take away health care dollars from something more medically useful.

Well said regarding the second-order effects of unnecessary testing. You should have heard the collective groan that happened in the military medical community when the "we're going to assess testosterone every year" announcement was made, in the middle of an already critical problem with insufficient access to care. I know of several docs who are actively counting the days until they can separate/retire. So much for evidence-based medicine.

 

[Mark K]

Well said regarding the second-order effects of unnecessary testing. You should have heard the collective groan that happened in the military medical community when the "we're going to assess testosterone every year" announcement was made, in the middle of an already critical problem with insufficient access to care. I know of several docs who are actively counting the days until they can separate/retire. So much for evidence-based medicine.

I feel for docs that have to deal with that. An even worse problem. Pop medicine of dubious value coming from the top down. I mean, it's not medically indicated as a screening test in the absence of suggestive symptoms, so why repeat the same mistake annually? A dubious diagnosis, now maybe leading to a dubious service connected disability...sigh...

 

[Mark K]

Genetic tests are actually quite affordable, BTW. I paid for some, insurance for some, the NIH for some, depending on who wanted what.
Easily the most bang per buck (though PSA is very cheap for PCa) for knowing what to watch for in the future. You only need to do it once, remember.

So, I'm not against tests per se. During my career I was one that tended to order more labs, ultrasounds, MRI's than the statistical average. I worked for a great organization that did not require any specialty or insurance approval to order most labs and radiological procedures. If the doctor felt it was indicated, he or she could order it.

But, periodically we would get polite "information scorecards" or something similar.

"Dr K, your lab/radiology ordering cost last year was equivalent to 2.7 million dollars. Comparable colleagues with similar care and quality outcome scores ordered 2.2 million annually. Here's what you ordered compared to your peers..."

It wasn't a punitive thing. Rather, it was a "please think and reflect on the value of tests that you order as your colleagues seem to have just as good quality and care for less," kind of thing. (I mean, I can't remember the exact dollar amount and made up those numbers, but it was in the 7 figure range...). None of it affected my reimbursement.

But wasted money is wasted money. The US already spends the most, as a percentage of GDP, for health care. There is no free money for any additional, new or questionably beneficial testing and treatment. Every additional test you ask for will result in higher premiums, higher taxes, or a worsening national debt. When you say, "my insurance will cover it," you're really saying "everyone else in America," or, alternatively, "all my POA buddies," should pay for it.

Like I said, I'm not against tests, but the real question is "what is the value of that test?" For many conditions and tests, that requires some thought.

 

[Kenny Phillips]

So, I'm not against tests per se. During my career I was one that tended to order more labs, ultrasounds, MRI's than the statistical average. I worked for a great organization that did not require any specialty or insurance approval to order most labs and radiological procedures. If the doctor felt it was indicated, he or she could order it.

But, periodically we would get polite "information scorecards" or something similar.

"Dr K, your lab/radiology ordering cost last year was equivalent to 2.7 million dollars. Comparable colleagues with similar care and quality outcome scores ordered 2.2 million annually. Here's what you ordered compared to your peers..."

It wasn't a punitive thing. Rather, it was a "please think and reflect on the value of tests that you order as your colleagues seem to have just as good quality and care for less," kind of thing. (I mean, I can't remember the exact dollar amount and made up those numbers, but it was in the 7 figure range...). None of it affected my reimbursement.

But wasted money is wasted money. The US already spends the most, as a percentage of GDP, for health care. There is no free money for any additional, new or questionably beneficial testing and treatment. Every additional test you ask for will result in higher premiums, higher taxes, or a worsening national debt. When you say, "my insurance will cover it," you're really saying "everyone else in America," or, alternatively, "all my POA buddies," should pay for it.

Like I said, I'm not against tests, but the real question is "what is the value of that test?" For many conditions and tests, that requires some thought.

For some, the "value of the test" is a CYA move due to a litigious society.

 

[bbchien]

CLL not in accelerated phase is a special issuance, but it's kind of a yawn of a special issuance. You see the oncologist annualy and provided his note and the CBC. When it starts to accelerate there is ample time to detect that the disease is lighting its engine.....

 

[Half Fast]

To one of the other replies: Have not been flying and wouldn't fly if feeling poor. Currently no treatments pending new prostate biopsy and would definitely self ground if under treatment (I saw a message regarding chemo from Dr Chien to another pilot here on this forum warning to make sure they're ok prior to flight).

CLL not in accelerated phase is a special issuance, but it's kind of a yawn of a special issuance. You see the oncologist annualy and provided his note and the CBC. When it starts to accelerate there is ample time to detect that the disease is lighting its engine.....

Regarding the OP’s original question, it sounds as though Basic Med shouldn’t be a problem for him if he wants to resume flying, in light of the above quotes.