OK to fly during "watch and wait"?
 

Hello. Diagnosed with low-grade Non-Hodgkin's (follicular) Lymphoma in and on tibia bone during summer, last year. Grounded myself immediately, as required. After months of deciding, opted to go with radiation and Rituxan (immunotherapy) only. Achieved a "complete response" and in remission, as of late last year. My First-Class medical was renewed in March, and just received my Special Issuance letter. I was told by many doctors that my disease is incurable and typically follows a remission/relapse cycle (although I can be in remission for many years).

My concern is that when it decides to relapse, because it will likely be slow-growing, my oncologist may decide it's best to just "watch and wait", until I start having symptoms again (pain in the knee). If it relapses, according to my special issuance paperwork, it's considered an "adverse change", and I'll have to immediately report it to Oklahoma City and ground myself yet again (according to the FARs).

Has anybody heard of the FAA allowing this (or any other type of slow-growing cancer) to be dealt with by "watching and waiting", and the FAA allowing one to keep his First-class medical certificate valid? If not, I believe this is something that needs to be changed, as not all cancers are aggressive, or limit a pilot's ability to perform his duties safely. One shouldn't have to ground himself just because a very slow-growing (highly-treatable) cancer is starting to relapse. They should allow the pilot to fly until the point where it (in the opinion of the pilot) just barely begins to become an issue in the flight deck. Can anybody understand where I'm coming from?

There must be somebody who can comment?

I *think* I recall hearing or reading that "watch and wait" is not acceptable to the FAA but I'm not sure about that at all.

Your AME (or maybe one who specializes in oncology) should be able to answer that. Or a consulting company like AMAS (I'd check out their website, the answer may already be there for you).

Any changes in condition make it impossible for your local AME to renew your medical:

https://i.ibb.co/KNWvQyV/AE76-B689-1...C19-BD7-EF.jpg


Watch and wait IS the standard of care for certain cases however, which means while it has to go back to OKC they can indeed approve a new SI if the treating physician can make a strong case for that option and come up with a monitoring schedule satisfactory to the FAA. Generally speaking that is more likely to be approved if it comes from a nationally recognized center like MD Anderson, Seattle Cancer Care Alliance, and similar.

THAT probably isn’t going to happen. Something about a multi six figure income tends to reduce the objectivity of the person with the condition. Hence the FAA wantS outside objective measurement where possible - be it for OSA, HIMMS, or whatever.

That multi-six figure income sure would help me when I have to ground myself! 😉 I wish! But I understand what you're saying.

I appreciate the responses.

@Panoose, any updates on this? I'm looking at a similar diagnosis and would be curious as to how your remission has held/how future SI's have gone? Hope you are well.