To dive or not to dive with bleomycin: a practical algorithm

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. 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. 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. 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