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Healthy living after treatment of childhood, adolescent, and young adult cancer

Bleomycin Alert
The lungs are very important organs that are responsible for supplying oxygen to the body and ridding it of carbon
dioxide. Sometimes, treatments given for childhood cancer can cause lung damage. Because you received bleomycin
during treatment for childhood cancer, it is important for you to learn about certain lung problems that can sometimes
happen after treatment with bleomycin. We also suggest that you read the Health Link: Pulmonary Health, whichcontains more information about your lungs and how to keep them healthy.
What are the problems that can happen after treatment with bleomycin?
People who received bleomycin during treatment for childhood cancer can sometimes develop lung problems many
years after their treatment has been completed. These problems may include:•

Lung inflammation (interstitial pneumonitis)•

Lung scarring (pulmonary fibrosis)•

Breathing problems associated with high levels of oxygen and/or intravenous fluids (acute respiratory distresssyndrome)

What is interstitial pneumonitis?
Interstitial pneumonitis is inflammation of the thin layer of tissue between the air sacs (alveoli) in the lungs. This
inflammation can worsen if a person develops lung infections, such as pneumonia. Interstitial pneumonitis that occurs
as a result of therapy with bleomycin sometimes develops after exposure to toxic fumes, tobacco, or high levels ofoxygen given over several hours.
What is pulmonary fibrosis?
Pulmonary fibrosis is the formation of scar tissue in the small air sacs (alveoli) of the lungs. This scarring makes thelungs stiffer and affects the exchange of oxygen and carbon dioxide in the alveoli. Pulmonary fibrosis may worsen overtime and can sometimes lead to early heart failure.
What is acute respiratory distress syndrome (ARDS)?
ARDS is a serious condition that occurs when alveoli in the lungs are damaged and can no longer provide oxygento the body. People who received bleomycin in the past may be at risk for developing ARDS, usually as a result of acombination of high levels of oxygen and large amounts of intravenous fluid given during surgery. However, the riskof developing ARDS is very low. If you need a medical procedure requiring oxygen or general anesthesia, be sure totell your surgeon, anesthesiologist, and other healthcare providers that you have received bleomycin in the past fortreatment of childhood cancer.
What are factors that increase the risk of developing lung problems after treatment withbleomycin?
•High total doses of bleomycin (400 units/m2 or more in all doses combined)•Radiation to the chest or lungs, or total body irradiation (TBI)

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Healthy living after treatment of childhood, adolescent, and young adult cancer•

Treatment with other chemotherapy drugs that can also damage the lungs (see related Health Link: PulmonaryHealth)•

Exposure to high oxygen levels (such as during general anesthesia or SCUBA diving)•Smoking•

Inhaled drugs, such as smoking marijuana, vaping, or cocaine

What monitoring is recommended for people who have received bleomycin for treatment ofchildhood cancer?
•A yearly medical check-up is recommended.

•Pulmonary function tests may show lung problems that are not apparent during a check-up. For this reason, it ishelpful to have these tests done at least once (at least 2 years after completing cancer treatment) to find out if
there are any problems. Your healthcare provider can decide if further testing is needed based on these results.

•In some cases, your healthcare provider may recommend repeating the pulmonary function tests if you arescheduled for surgery that requires general anesthesia to check for changes in the lungs that could increase therisk of breathing problems during or after anesthesia.

Are there any special precautions I should take?
If you received therapy with bleomycin, you should:•Avoid SCUBA diving, unless you have had a complete check-up and have been advised by a pulmonologist (lungspecialist) that diving is safe. During SCUBA diving, increased underwater pressures and high oxygen levels candamage the lungs.

•Tell your surgeon, anesthesiologist, and other healthcare providers about your medical history before anyscheduled procedures that may require oxygen.

•Avoid breathing high concentrations of oxygen whenever possible, especially for long periods of time (such asover several hours). If you require oxygen, monitoring of your oxygen levels can usually be done so that you canreceive the lowest oxygen concentration that is necessary.

•Get the pneumococcal (pneumonia) vaccine.

•Get yearly influenza (flu) vaccines.

•Don’t smoke or use inhaled drugs such as marijuana, vaping, or cocaine. If you currently smoke, talk to yourhealthcare provider about a program to help you quit.

Written by Margery Schaffer, RN, MSN, CPNP, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
Reviewed by Leeann Carmichael, DNP, APN, FNP-BC; Melissa Acquazzino, MD, MS; and Kayla L. Foster, MD, MPH.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or youngadulthood.
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Healthy living after treatment of childhood, adolescent, and young adult cancer
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying HealthLinks were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’sOncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding a
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