Bleomycin and scuba diving: to dive or not to dive?

Area of Science:

• Oncology
• Pulmonary Medicine
• Hyperbaric Medicine

Background:

• Bleomycin is a chemotherapy agent used for testicular cancer and lymphoma.
• Bleomycin induces DNA damage and generates reactive oxygen species (ROS) by chelating iron and interacting with oxygen.
• High oxygen concentrations are known to exacerbate bleomycin-induced pulmonary injury.

Observation:

• A young male patient successfully treated with bleomycin for testicular cancer sought advice on returning to scuba diving.
• Scuba diving involves exposure to high partial oxygen pressures, increasing with depth.
• The duration of pulmonary risk following bleomycin treatment remains unclear.

Findings:

• The patient was advised against resuming scuba diving due to the potential for exacerbated pulmonary injury.
• The risk is associated with the interaction of bleomycin-induced ROS and the high oxygen environment encountered during diving.

Implications:

• This case highlights the potential risks of hyperoxia for patients with a history of bleomycin chemotherapy.
• Further research is needed to determine the safe duration of risk and guidelines for high-oxygen activities post-bleomycin treatment.
• Physicians should counsel patients treated with bleomycin about the risks of activities involving elevated oxygen exposure, such as scuba diving.