Cancer, including sarcoma, leukaemia etc. (ILO/IMO Guidelines C 00-48)

Impairment and Risks

There is a wide range of risks depending on the location of the cancer, its pattern of growth and the treatment used. These may result in loss of current capabilities. In a few cases a risk to others when doing safety-critical tasks arise from seizure risks because of growths located in the brain. More commonly there is an increased risk to the individual from the risk of recurrence or complication that need urgent shore-based treatment.

a) direct effects from tumour. These entirely depend on its location but include pain, bleeding, damage to function of organ such as obstruction (intestines, lung); seizure (brain).
b) effects from spread or recurrence. Each form of tumour has a characteristic pattern of spread. This may remain local or be to distant parts of the body especially liver, lymph nodes, bone, brain. Each of these sites can lead to their own symptoms. Spread to the brain is particularly important as the first sign of this may be a seizure (more common from lung, melanoma).
c) side effects of treatment. Surgery and radiotherapy may reduce function because of local scarring or from damage to the function of organs affected. Chemotherapy can reduce immune responses and increase the risk of infections
d) general debilitation. The disease itself, if advanced, as well as many of the treatments used can reduce performance and stamina. This may be from diagnosable and treatable effects such as anaemia or be without a detectable cause.

Rationale and justification

• There is little evidence specific to seafarers. Increases in cancer incidence found in studies generally relate to lifestyle causes but agents such as asbestos and carcinogenic chemicals have contributed in the past.
• Cessation of smoking, the diet eaten and the extent of exposure to the sun can all influence the development of cancer and are amenable to control while working at sea.
• There good information on the average prognosis and the effects of treatment for most types of cancer. Often the pathological findings at initial surgery in terms of cell type and extent of local invasion are important predictors of prognosis.
• There is little information on the frequency of the sorts of incapacitation that are relevant to fitness to work as a seafarer.
• One area where there is useful data is on the probability of primary brain tumours or secondary growths in the brain presenting as seizure, and hence likely to interfere with safety critical duties.

Clinical assessment and decision taking

The complexity of clinical care requirements and surveillance means that the examining doctor will often need to contact the responsible clinician to ask specific questions about the risks under the anticipated working conditions of the person while at sea to assist with decision taking on fitness. The doctor may also need to discuss how the pattern of work of a seafarer can best be integrated with continuing clinical care requirements to ensure both that care is not compromised and that duties can be undertaken effectively and without risk.

a) Strong suspicion of cancer identified at medical – Temporarily unfit
b) Cancer or suspected cancer being investigated and while treatment being established - Temporarily unfit
c) Investigation complete and treatment stabilised.

Obtain report from treating doctor on pathology, prognosis especially any current or anticipated forms of impairment from the disease or its treatment and the future needs for treatment and surveillance. It will assist with the report if the doctor supplying it is made aware of the performance and reliability requirements of the seafarer's duties and asked to comment in relation to these.

Assess fitness using the following items of information. Take the most restrictive classification from the answers to the questions below.

Advice to seafarer

If there is a requirement to take anti-cancer medication while at sea then consider needs for safe storage and administration of medication as well as need for advice on use in the event of adverse effects, infection, other illness or injury. Advise seafarer and, with their agreement, the employer.