Information
Radiation pneumonitis most commonly develops 1 to 3 months after radiotherapy and can happen up to 6 months after treatment.
Chemotherapy pneumonitis can occur at any point during treatment. The most common causative drugs are Blemoycin, Mitomycin Cyclophosphamide, taxanes, immunotherapies, Methotrexate and Gemcitibine. Oral tyrosine kinase inhibitors (eg Erlotinib, Imtanib) can also pneumonitis.
Most common symptoms are acute or sub acute dyspnoea, new or worsening cough which after history and examination does not reveal pneumonia, tumour recurrence, or any other specific aetiology.
Who to refer:
Any patient with a cancer diagnosis who is on treatment, within 6 weeks of treatment, has had immunotherapy within last 12 months or who is under oncology follow up who has symptoms of pneumonitis.
Who not to refer:
If in doubt please do not hesitate to call the on call oncology team to discuss.
How to refer:
Contact the Acute Oncology team at the Edinburgh Cancer Centre on 07798774842 or 0131 537 1000 and ask to speak to Acute Oncology team for oncology.
There is a high mortality from treatment related pneumonitis so if suspected please discuss with oncology. High dose steroids are usually indicated.
All patients on or within 6 weeks of treatment should be encouraged to monitor symptoms and call Cancer Treatment Helpline (CTH) on 08009177711 if any treatment related concerns. Please note the CTH is a call operator service provided by NHS 24 who then refer on to acute care specialist. They are not able to give specialist advice. Note if a patient has presented to primary care for assessment the patient should not be advised to call the CTH to pass on this information or seek further advice. The primary care clinician should call the Acute Oncology team at the Edinburgh Cancer Centre to discuss if appropriate.
Link to Acute Oncology Initial Management Guidelines:
UKONS | Acute Oncology Initial Management Guidelines (sundownsolutions.co.uk)
