Information
Radiation pneumonitis most commonly develops within the three months of completing radiotherapy, but can happen up to six months after treatment.
Chemotherapy pneumonitis can occur at any point during treatment. The most common causative drugs are bleomycin, mitomycin cyclophosphamide, taxanes, methotrexate and gemcitabine. However, any chemotherapy can theoretically cause pneumonitis and so if there are any concerns, please make contact with the Acute Oncology team.
Immunotherapy drugs (eg pembrolizumab, ipilimumab, nivolumab, durvalumab, atezolizumab) are commonly used in cancer care now; all have the potential to cause severe pneumonitis at any time (from commencement to 12 months after stopping).
Antibody drug conjugates are an emerging class of drugs and some are particularly prone to causing pneumonitis, most notably Enhertu (traztuzumab deruxtecan).
Oral targeted agents (eg osimetinib, erlotinib, imtanib, olaparib, niraparib) can also cause pneumonitis.
For all these agents, the most common symptoms are acute or sub acute dyspnoea, and new or worsening cough which after history and examination does not reveal pneumonia, tumour recurrence, or any other specific aetiology
M.A, K.E & J.W. 12-2-26
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.
All patients on or within six weeks of treatment should be encouraged to monitor symptoms and call The Cancer Treatment Helpline (CTH; 08009177711) with any treatment-related concerns. Please note, the CTH is a call operator service provided by NHS 24, who then refer on to an acute care specialist. They cannot give specialist advice.
If the patient has been assessed by a healthcare practitioner in Primary Care, and Oncology advice/input is felt to be required, the Primary Care clinician should call the Acute Oncology team at the Edinburgh Cancer Centre (based in the WGH) and discuss directly. The Acute Oncology team can be contacted during working hours (Mon-Fri 9-5) on 07798774842; If out of hours, please discuss with the Oncology Registrar On-Call via NHS Lothian Switchboard (0131 537 1000).
If the primary care clinician requires any further guidance on the suitability of referral to Acute Oncology, they can consult Pg 10 of the The UKONS Oncology/Haematology 24 Hour Triage Toolkit.
Note if a patient has presented to primary care for assessment, the patient should NOT be advised to call the CTH themselves to pass on this information or seek further advice.
Link to Acute Oncology Initial Management Guidelines:
UKONS | Acute Oncology Initial Management Guidelines (sundownsolutions.co.uk)
