travelling to australia with cancer

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Travelling to or from Australia with medicines and medical devices

You can enter Australia with medicines for you or an immediate family member travelling with you under the traveller’s exemption. When leaving Australia, you must follow the advice of the country you are entering.

Travelling to Australia with medicines and medical devices

The traveller's exemption allows people entering Australia to bring with them for their own personal use or the use by an immediate family member who is travelling with them:

• carry 3 months’ worth of medicine
• any medical devices.

Australian residents require a valid prescription from an Australian doctor for the medication they are travelling with. International visitors should have a valid prescription from their doctor.

Prescription medicines such as morphine, oxycodone, methadone, methylphenidate, Adderall®, and benzodiazepines are all covered by the traveller exemption.

Steps to take before travelling

• Obtain a prescription to confirm that the medicines you are carrying have been prescribed to you OR provide a letter from your doctor that states you are under their treatment and that the medication(s) you are carrying have been prescribed for your personal use. Your doctor's letter must specify the name of the medicine and dosage.
• Ensure the medication remains in its original packaging with the dispensing label intact. This will assist with identifying each substance at the border.
• Be ready to declare all medication to the Australian Border Force upon arrival.

If you need more medication

If you have run out of medication or you will run out of medication during your stay in Australia, you may visit an Australian registered prescriber (for example, a General Practitioner, Nurse Practitioner, Dentist) to obtain a valid Australian prescription. The prescription can be used to purchase medication from Australian pharmacies. Alternatively, if the item is not restricted in Australia a maximum of 3 months’ supply can be imported from overseas.

Special notice concerning codeine medications

All medications containing codeine require a prescription from your medical doctor.

For any medication containing codeine, of any strength, that you bring into Australia for your own personal use, you must have a prescription or letter from your doctor. You must comply with all other traveller’s exemption requirements.

Prohibited items

Travellers may not bring the following substances into Australia:

• Abortifacients (for example, mifepristone – RU486)
• Yohimbe (Yohimbine)
• Aminophenazone, amidopyrine, aminopyrine, dipyrone, metamizole
• Amygdalin/laetrile.

Travelling from Australia with medicines and medical devices

We recommend that all Australians who are planning to travel overseas with medication follow the same travel advice given for travellers entering Australia under the traveller's exemption.

It is important to note that some countries have very strict rules regarding certain types of medications (especially narcotics and medicinal cannabis products), being brought into their country. The Office of Drug Control is not able to provide advice on the exact rules and regulations of each country.

If you have concerns about the medication you are travelling with, check the 'Health' section of the country in question on  SmartTraveller .

The Office of Drug Control is not able to authorise documents to confirm legal authority of the traveller to possess a medication. If a person is travelling to a country that requires official documentation endorsed by the government, we recommend that you follow the advice made available at SmartTraveller .

Pharmaceutical Benefits Scheme (PBS) and travel

Medicines supplied under the PBS are subsidised by the Australian Government for personal use only. Any medicines that are suspected to be taken overseas for somebody else may be seized by border officials.

Carrying PBS medicines overseas for someone other than you or an immediate family member travelling with you on the same aircraft or ship is illegal. It carries penalties of up to $5,000 and 2 years imprisonment.

Read more about how to manage your PBS medicine overseas .

Country-specific advice for travel with medicines

Find out more information about staying healthy and travelling with medicines to specific countries at the  SmartTraveller website .

Travel enquiries

For more information, please visit Travelling with medicines and medical devices on the Therapeutic Goods Administration (TGA) website.

For any travel enquiries, please contact the TGA:

• phone  1800 080 653
• email [email protected]
• or by webform here .
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• Breast cancer

Women who live outside a major city may need to travel to see a specialist surgeon, radiation oncologist or medical oncologist.

Once the treatment plan has been decided, it’s usually possible to have chemotherapy at a hospital in the nearest regional town. However, some women have to travel for surgery and radiotherapy.

It may be possible for women who need to travel to get financial assistance, accommodation or other practical help during treatment.

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Planning holidays and travelling with cancer

Planning travel

You may have dreams of just getting away from it all and travelling. The good news is that for most people this is still possible, but it may involve more preparation and may limit some of the things you can do and the places you can visit. Talk to your treating healthcare team about travelling. 

Vaccinations 

Depending on the type of cancer and treatments you’ve had, you might not be able to get the vaccinations you need to travel to some parts of the world. Check with your treatment team.

Travelling with drugs

If you are still on medication when you travel, it is important to make sure you have enough supplies to last the whole trip. You should also take extras.

Some countries limit the amount of particular drugs that you can take into the country. Your travel agent can check this out or you can contact the Australian Embassy .

For certain drugs, like morphine, you may need a letter from your doctor. This will also be helpful if you’re taking syringes, needles or portable medicine pumps with you. Carry any medical letters in your hand luggage so you have easy access to them at customs and security checkpoints.

Medical records

It is also a good idea to take printed and digital copies of medical files, in case you need to access treatment while you are away. A trusted family member can hold a copy of these documents so they can email them to you if needed. 

There are some situations where you may not be able to fly because oxygen levels and air pressures change at certain altitudes. You may have to wait or find a place to go by car or train, if you are breathless, anaemic, have had recent surgery, or have a brain tumour and there is a chance of swelling in the brain.

Travel insurance

Getting travel insurance when you’ve had cancer can be more difficult because of the cancer history increasing the risks to the insurance company. They assume that you are more likely to:

• Get sick and need treatment while you’re away
• Need to come home for treatment
• Cancel your trip because you fall ill before going.

This doesn’t mean you can’t get insurance, but it might just mean you have to shop around. How much it will cost and who will insure you will depend on things like if you are currently having treatment, what cancer you have and how old you are. Make sure you check out the fine print about what is covered.

Cancer Council NSW has a factsheet about insurance for people with cancer. Visit Cancer Council  and search for ‘new insurance policies’.

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Travel and accommodation assistance during cancer treatment

Home » Living well » Practical support » Travel and accommodation

Travel and accommodation when undergoing treatment

Many people with cancer may have to travel a distance to their medical appointments regularly. Some will also require accommodation while they are having treatment. These costs add up quickly and cause undue anxiety for the patient and family. Travel and accommodation support during cancer treatment may help ease the burden.

Pancare Foundation provides some financial support for travel and accommodation costs for people who have to travel to special medical services across Australia. ​

Learn more: > Financial support and assistance

Hospital services and supports

Patients may be able to get assistance with parking, travel and accommodation to partake in medical services.

The social worker at the hospital will be able to check what services or supports you may be eligible for. ​If you have not met with a social worker your specialist nurse or doctor can refer you.

Some hospitals have a dedicated Patient Accommodation Manager who can assist patients to book suitable accommodation during treatment with one of their partner organisations located nearby.

Patients living in excess of 50km (one way) in some states from the hospital may be eligible for government subsidy and should discuss this with the Patient Accommodation Manager when exploring accommodation options.

Within major hospitals limited internal accommodation is also available to patients. For more information please speak to your medical unit or liaison nurse about eligibility and availability.

Medistays in an online accommodation directory helping patients and families find accommodation near their treating hospital. Their website below has a variety on accommodation choices in all states and territories throughout Australia

Learn more: >Medistays websit e

Fight Cancer Foundation

The Fight Cancer Foundation support services include helping rural and interstate patients accessing major treatments in New South Wales, Tasmania and Victoria secure affordable accommodation.

Learn more: > Fight Cancer website

Carer Gateway

This government website has been designed by carers for carers. The site includes information regarding different transport options for patients in each state.

Learn more: > Carer Gateway websit e

Health services and hospitals often offer a reduced parking rate for patients and carers. Remember to ask at your health service or hospital if it is possible to obtain a reduced parking rate for you and family members.​

Travel and accommodation assistance for cancer patients during treatment varies from state to state.

Each State Government within Australia funds a program subsiding the transport and accommodation of patients who live a great distance from their nearest approved treatment centre.

Cancer Council

Last financial year, Cancer Council NSW supported 32 patient transport services. The Transport to Treatment drivers made 19,070 trips, covering more than 1,035,000 km

To find out if this service is available in your state please call Cancer Council 13 11 20 Information and Support.

Isolated Patients Travel & Accommodation Assistance Scheme (IPTAAS )

The IPTAAS is a NSW Government initiated scheme designed to assistance patients that travel long distances for specialist medical treatment. IPTAAS is available for patients who live more than 100kms from their nearest treating specialist or if the combined trips to and from the specialist exceed 200kms per week.

The subsidy for travel in private vehicle is 22 cents per km.

Public transport is reimbursed less the GST and any booking fee components. Private stay accommodation is reimbursed at $20 per person, per night.

Please visit the IPTAAS website to learn more about other available subsidies and to check if you are eligible for this scheme.

Cancer Council NSW

Cancer Council NSW have a partnership with Accor Hotels, providing accommodation at reduced rates.

For more information, please visit their website .

Major hospitals within NSW also have a listing of suitable accommodation within their area. Please speak to your hospital social worker or specialist nurse and they will connect you with the appropriate hospital department to access this service.​

Patient Travel Subsid Scheme (PTSS )

The PTSS can assist patients that live in rural remote areas and is available to patients who are required to travel more than 50km to specialist medical services that are not available locally. Travel subsidies for commercial travel (air, bus or rail) are fully reimbursed at the lowest discount rate. The subsidy for travel in a private vehicle is 30 cents per km, and private stay accommodation is reimbursed at $10 per person, per night.

Please review the website for conditions and to check if you are eligible for this scheme.

Cancer Council QLD

CCQLD have 6 accommodation lodges located across Queensland in:

• Brisbane (south and northside)
• Rockhampton

Accommodation available to support patients and families during their treatment

Patient Assisted Travel Scheme (PATS)

The PATS is a WA Government initiated scheme funded by Royalties for Regions. This scheme provides subsidy towards the cost of travel and accommodation for patients that travel more than 100km from their nearest eligible medical specialist service (including a telehealth service). PATS also subsidise flights for patients living more than 16 hours’ drive from the nearest treatment centre.

Please review the website for conditions and to check if you are eligible for this scheme

Cancer Council WA

Cancer Council WA also have 2 accommodation lodges located in Perth, Crawford and the Milroy Lodge.

The PATS is a scheme that provides subsidy towards travel, escort and accommodation costs when rural and remote South Australians travel over 100 km each way to see a specialist.

PATS offers a fuel subsidy of 16 cents per km for car travel, a payment towards the cost of public transport where this is approved, or a payment towards the cost of air travel if this is deemed essential by your local doctor. Conditions apply for Air Travel.

SA Health provide a range of subsidies to assist different patient needs regarding travel. Patients are entitled to claim from one scheme only. If they meet all the PATS criteria, they will be directed to apply to PATS.

Cancer Council SA

Cancer Council SA has two accommodation lodes in Adelaide for country people affected by cancer and their carers. Two lodges are Flinders and Greenhill Lodge.

PATS is a subsidy program funded by the Northern Territory Government to provide financial assistance to Territorians who are referred by an approved practitioner to the nearest approved specialist medical service. To qualify for the subsidy, travel is to be more than 200 km one way to an approved specialist medical service, or more than 400 km cumulatively in one week for renal or oncology treatment.

For assistance please contact your local PATS office:

Royal Darwin Hospital:   8922 8135

Katherine Hospital:  8973 9206

Gove District Hospital: 8987 0201

Alice Springs Hospital:  8951 7846

Tennant Creek Hospital:  8962 4262

Interstate Patient Travel Assistance Scheme (IPTAS)

IPTAS provides assistance to permanent residents of the ACT towards travel accommodation expenses incurred when referred interstate for medical treatment not available in the ACT. There are many exclusions for ACT

Patient Travel Assistance Scheme (PTAS)

Patient Travel Assistance Scheme (PTAS) provides financial help with travel and/or accommodation costs to Tasmanian residents who need to travel:

• more than 50 km (one way) to the nearest oncology or dialysis treatment centre
• more than 75 km (one way) to the nearest appropriate specialist medical service
• more than 75 km (one way) to access lymphoedema treatment

from their permanent residence. Benefits are only paid for interstate referrals when the treatment is unavailable in Tasmania.

Victorian Patient Transport Assistance Scheme (VPTAS)

VPTAS subsidises costs incurred by rural Victorians who travel more than 100km one way or an average of 500 km a week for one or more weeks to receive approved medical specialist services or a specialist medical treatment. Patients have to pay the first $100 each treatment year. People who are eligible for travel will receive 20 cents per km if a private car has been used. A full reimbursement will be given at economy rate for public transport.

Travellers Aid

Travellers Aid is a not for profit organisation that provides the following services for people that require assistance in the Melbourne CBD

Travellers Aid Australia operates from our three service sites at Southern Cross and Flinders Street Stations in Melbourne and Seymour Railway Station, in regional Victoria.

Services provided include:

• Buggy & Guidance Service
• Pick-up service from the bus, taxi or train platform and be taken to taxi or prearranged transport at the Southern Cross Station or can also be arranged at Flinders Street Station.

The Buggy Service is utilised by the vision impaired or people having difficulty with their mobility.

Medical Companion Service

If you are not comfortable with where to go in Melbourne or do not like travelling on transport alone, a medical companion can be booked. A volunteer will accompany you from the station to your medical appointment and bring you back to the station for your return transport home.

LINK Community Transport Inc

LINK Community Transport Inc is a not for profit organisation providing transport solutions for people and communities in Melbourne, Victoria.

The service provides door to door transport for people in the community for a variety of reason from personal, social, recreational, educational and health needs.

This is a great service that keeps people in touch with community and delivers them to medical appointments with no stress.

LINK currently operates in 108 suburbs in the Northern and Western suburbs of Metropolitan Melbourne. Most people are eligible for a subsidy so the cost personalised door to door service can be as little as $4.

LINK also services private customers who aren’t eligible for a subsidy at a competitive rate equivalent to a half price taxi.

For further information please contact the office on 1300 54 65 28 or review the website .

Red Cross Transport

Red Cross Transport has a limited availability to provide assistance with travel to essential medical appointments. The hospital will contact Red Cross to organise transport one week before required. If the service is available, you will need to contact Red Cross and confirm transport 3 days before required.

Learn more: > Red Cross websit e

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Traveling With Cancer: Advice, Tips, and Tricks

How to know when you shouldn’t be traveling with cancer, how to prepare to travel safely, and what you can do to reduce the stress and cost of traveling

A trip or vacation with family and friends can be a great way to take your mind off the events surrounding your cancer diagnosis and treatment. But when faced with the need to travel, whether it's for a vacation, business purposes, or to get treatments, it’s natural for people with cancer to wonder if it would be unsafe.

“It’s generally safe to travel with cancer, even on longer [more than five-hour] flights,” says Jeffrey Velotta, MD , a cardiothoracic surgeon with extensive expertise in pleural mesothelioma and lung cancer.

Still, it’s important to know when you shouldn’t travel with your condition, what and how to prepare to travel safely, and what you can do to reduce the stress and cost of traveling.

When Not to Travel With Cancer

While it is generally considered safe for people with cancer to travel, there are times when you should cancel your plans and stay home. “The caveats are that if you had a major cancer surgery within four to six weeks, or if you are actively undergoing chemotherapy and have had an infusion within one week, you shouldn’t travel, because of possible feelings of dehydration, nausea or vomiting, or severe fatigue,” says Dr. Velotta, adding that being on longer flights can worsen these symptoms.

Notably, there are no established regulations or criteria to deem a person with cancer unfit to travel. But, according to a review article published in the Journal of Global Oncology , people who are receiving intensive radiation or systemic cancer treatments, those whose cancer requires close monitoring by healthcare professionals, or those with stage 4 cancer should not travel on commercial airlines.

Possible Dangers of Traveling With Cancer

It’s important to be aware of the potential risks when traveling with cancer.

• The stress from being on a flight or on the road for a long time may worsen your symptoms or have negative impacts on your overall health.
• It may be difficult to get medical care or emergency medical intervention while in transit.
• You may experience reduced oxygen delivery on a flight if you are an older adult, have low levels of healthy red blood cells (anemia), or have an existing cardiopulmonary disease such as bronchitis (inflammation of the lung airways) or polycythemia (a blood disorder where you have too many red blood cells).
• Your risk of venous thromboembolism (VTE), which is a blood clot that forms in the veins, may be higher if you have cancer and are traveling for over eight hours.
• People with cancer who travel by air may experience pleural effusion (fluid in the lungs) or pain.
• If you had a brain tumor and underwent a recent neurosurgery, you may be at risk of increased pressure within your skull when you travel at a high altitude.

And there is another potential danger of traveling with cancer: “You are potentially at a higher risk of contracting COVID-19 and other upper respiratory infections or viruses,” Velotta points out, suggesting that you should avoid traveling or delay your flight if you feel sick.

Should You Inform Anyone About Your Condition?

Before traveling, there are some key people you should consider speaking with or informing about your condition.

“If you're dealing with cancer and planning a trip, talk to your healthcare team. Your provider can confirm whether it's safe to travel and offer tips on managing things while you're away,” says Sean Marchese, RN , a nurse at the Mesothelioma Center, an advocacy organization in Orlando, Florida, with a background in oncology clinical trials and over 20 years of patient-care experience.

Your doctor can arrange for the medications you will need to take with you and determine whether you will need a medical alert letter or special documentation for your medication. For instance, this might be necessary if you are taking a synthetic opioid like methadone for cancer-related pain.

You can get advice from your other healthcare team members, like the nurse and patient navigator, about the following:

• Where and how to buy travel health insurance
• How to cope with symptoms and medication side effects when you are away from home
• Other essentials you will need to take with you on the trip

While it's not obligatory, some people may want to inform their flight attendants and seatmates about their medical condition. “It's wise to tell the flight crew about your health, especially if you anticipate needing help. Communicating your needs keeps everyone in the loop in case of an emergency,” Marchese says.

Prepare for Your Trip

Here are some tips to help you plan and prepare for a safe trip.

• Notify your healthcare team ahead of time about your travel plans. If you are undergoing treatment, they can arrange a break or change the treatment dates.
• Pack your prescribed medications and take them as directed before and during the flight.
• Consider speaking with the travel company you will be using so they can provide you with any needed support, such as a wheelchair.
• Arrange to get travel insurance, in case you need it.
• If you had surgery, speak to your doctor about any extra supplies you need to carry with you.
• Carry your face mask, alcohol-based hand-sanitizing gel, and sunscreen with you.
• Wear compression socks to improve blood flow and reduce leg swelling during the trip.
• If your cancer is causing you bowel or bladder problems, consider getting a “Just Can’t Wait” toilet card or booking an aisle seat close to the lavatory. You can also download a toilet app on your phone to help you find public restrooms when you arrive at your destination.
• Pack healthy snacks like sliced apples and peanut butter, whole-grain crackers, and nuts. Make healthy food choices even when you get to your destination.
• Plan to stay active. If you are on a long road trip, use rest-stop breaks to stretch and take a short walk. For plane trips, you can explore the airport while waiting for a connecting flight or try simple inflight exercises (for example: pull each knee up toward the chest and hold it there with your hands for 15 seconds, and repeat).
• Drink enough water, and avoid consuming excess alcohol or caffeinated drinks during your trip.

For more travel health information, speak to a travel health specialist or visit the Centers for Disease Control and Prevention for information on diseases that are of concern at your destination and vaccines that may be recommended for you.

Medical Travel Agencies and Travel Health Specialists

In the wake of the COVID-19 pandemic, it has become particularly risky for people with medical conditions like cancer to travel through public transport systems. This is because cancer and its treatments can suppress the immune system, making it harder for the body to fight off infections.

For people with cancer who are in critical condition or are receiving treatment, it may be helpful to seek the services of healthcare travel agencies that can connect them with affiliated hospitals at their destinations and provide medical air services or medically equipped buses. Such planes or buses may be outfitted with intensive care facilities, medications, and even trained medical personnel. You can visit the International Medical Travel Journal’s directory and search for medical travel agencies around your location that offer such services.

Another option is to consult a travel health specialist before you go. In collaboration with your oncology team, a travel health specialist can advise you on how best to protect yourself from illnesses transmitted by insects or parasites such as ticks and mosquitoes, depending on the region you're traveling to and the time of year. They can also recommend vaccines you should get. “Vaccines depend on where you're going. Many places require flu and pneumonia shots, but it varies,” says Marchese.

"Generally speaking, lung cancer or cancer spread to the lungs will have a higher risk of worse upper respiratory symptoms or pneumonias," adds Velotta. So, if you have this type of cancer, you need to ensure your boosters for COVID-19 are up-to-date.

Traveling with cancer can come with additional costs that some families may not be able to afford. Speak with your medical team, a patient navigator, or a social worker to learn about resources that can help with the cost of transportation, food, lodging, and other needs.

If you are traveling to get medical treatment, check out the American Cancer Society’s list of programs and resources for help with cancer-related expenses.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

• Heng S et al. Traveling With Cancer: A Guide for Oncologists in the Modern World. Journal of Global Oncology . July 10, 2019.
• Aerospace Medical Association Medical Guidelines Task Force. Medical Guidelines for Airline Travel, 2nd Edition. Aviation, Space, and Environmental Medicine . May 2003.
• Brändström H et al. Risk for Intracranial Pressure Increase Related to Enclosed Air in Post-Craniotomy Patients During Air Ambulance Transport: A Retrospective Cohort Study With Simulation. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine . May 12, 2017.
• Ahmedzai S et al. Managing Passengers With Stable Respiratory Disease Planning Air Travel: British Thoracic Society Recommendations. Thorax . September 2011.
• Why People With Cancer Are More Likely to Get Infections. American Cancer Society . March 13, 2020.
• Blood Clots and Travel: What You Need to Know. Centers for Disease Control and Prevention . June 28, 2023
• Opioids for Cancer Pain. American Cancer Society . May 23, 2023.
• Travelers With Chronic Illnesses. Centers for Disease Control and Prevention . August 16, 2022.
• Destinations. Centers for Disease Control and Prevention .
• Eat Right and Stay Active While Traveling. American Cancer Society . November 21, 2019.
• Programs and Resources to Help With Cancer-Related Expenses. American Cancer Society . September 30, 2023.

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Home » Cancer research » Viertel Cancer Research Centre » Health Systems and Behavioural Research » Travelling for Treatment

Travelling for Treatment

The Travelling for Treatment project aims to understand more about the experiences of regional Queenslanders who must travel to receive cancer treatment. Participants include guests staying at the Cancer Council Queensland (CCQ) accommodation lodges and their carers.

The accommodation lodges are independent living facilities that provide a home away from home for those who need to travel to access cancer treatment. CCQ’s Viertel Cancer Research Centre worked alongside the Cancer Support and Information department and staff at six state-wide CCQ accommodation facilities to recruit patients to share their story.

The University of Southern Queensland is a study partner.

Study background

Cancer diagnosis in rural and regional Australia is unfortunately associated with poorer survival rates and lower quality of life when compared to metropolitan areas. This is concerning, considering 30% of all Australians live outside a major population centre. The reasons for this disparity are not understood, but are likely to include a range of factors such as access to services, socio-demographic and lifestyle factors, unique to non-metropolitan Australians, that exacerbate the challenges associated with living with and treating cancer.

In 2017, the Travelling for Treatment project was commenced to help address these concerns. The project is a longitudinal investigation into the experiences of regional and rural cancer patients and their carers who must travel far from home to receive healthcare. The project aims to provide a deeper understanding of the unique needs and challenges faced by regional Queenslanders affected by cancer.

Participants and project design

Over recent years, all patients who have stayed at the CCQ accommodation lodges and, if possible, their support person or carer, have been asked to participate in the study.

People who agree to take part are asked about the course of their cancer treatment starting with their diagnosis, as well as topics including their satisfaction with healthcare and quality of life. This is done through face-to-face telephone interviews and self-completed questionnaires that are mailed to participants when they join the study and then at 3 months, 12 months and annually thereafter until 5 years.

To capture a thorough understanding of the patient’s cancer diagnosis and treatment, signed consent of participants to access their Medicare and Pharmaceutical Benefits Scheme data as well as records from the Queensland Cancer Register and relevant medical practitioners are also sought.

HREC reference number H17REA152

Current status

Recruitment for the project began in 2017 and finished in 2020. A total of 810 cancer patients who stayed at the CCQ accommodation lodges and 252 carers agreed to participate. All participants are followed for 5 years after their diagnosis. By the end of 2022, the first participants will be entering their 5th and final year of follow up in the study.

For more information

For project questions, please contact the research team by calling (07) 3634 5344 or emailing [email protected] .

For any other questions or support please call Cancer Council Queensland on 13 11 20 between the hours of 9am to 5pm, Monday to Friday (excluding public holidays).

Publications

Below are the peer-reviewed publications that have resulted from the Travelling for Treatment project. Click on the corresponding links to read more about each of the research papers and the implications for cancer control.

• Goodwin BC, Crawford-Williams F, Ireland M, March S, Chambers SK, Aitken JF, Dunn J. The quality of life of regional and remote cancer caregivers in Australia. European Journal of Cancer Care. 2022. doi: 10.1111/ecc.13587:e13587. Read summary
• Rowe A, Crawford-Williams F, Goodwin BC, Myers L, Stiller A, Dunn J, Aitken JF, March S. Survivorship care plans and information for rural cancer survivors. Journal of Cancer Survivorship. 2022. doi: 10.1007/s11764-022-01204-0. Read summary
• Crawford-Williams F, Goodwin BC, Chambers SK, Aitken JF, Ford M, Dunn, J. Information needs and preferences among rural cancer survivors in Queensland, Australia: a qualitative examination. Australian and New Zealand Journal of Public Health. 2021. doi: 10.1111/1753-6405.13163. Read summary
• Stiller A, Goodwin BC, Crawford-Williams F, March S, Ireland M, Aitken JF, Dunn J, Chambers SK. The supportive care needs of regional and remote cancer caregivers. Current Oncology. 2021; 28(4):3041-3057. doi: 10.3390/curroncol28040266. Read summary
• Goodwin BC, Chambers S, Aitken J, Ralph N, March S, Ireland M, Rowe A, Crawford-Williams F, Zajdlewicz L, Dunn J. Cancer-related help-seeking in cancer survivors living in regional and remote Australia. Psycho-Oncology. 2021. doi: 10.1002/pon.5643. Read summary
• Dunn J, Goodwin B, Aitken J, March S, Crawford-Williams F, Ireland M, Ralph N, Zajdlewicz L, Rowe A, Chambers SK. Are National Cancer Control Indicators for patient experiences being met in regional and remote Australia? A cross-sectional study of cancer survivors who travelled for treatment. BMJ Open. 2021. doi: 10.1136/bmjopen-2020-042507. Read summary

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Travelling for treatment

People who live outside a major city may need to travel to see a specialist surgeon, radiation oncologist or medical oncologist. Travelling to treatment can be challenging, especially when travelling away from home or for treatments which last for many weeks or months.

Travelling far from home can place further stress on people affected by cancer.

Cancer Council SA has two accommodation facilities in Adelaide for country people affected by cancer and their carers. Our Lodges provide a friendly place to stay, with transport to some treatment centres and support services, to make your stay as comfortable as possible.

If you live in rural South Australia, it’s likely you’ll need to travel to a larger city (often Adelaide) for cancer treatment. Having to travel for treatment can bring uncertainty around the costs involved, logistics of getting there and the social and emotional support available.

It’s important to consider, plan for and seek support regarding where to stay and how you’ll get there, time off work, the disruption to your normal routine and being away from family and friends.

This may be overwhelming and as a result, some people who live in rural areas consider putting off or refusing treatment that requires travel. If you’re struggling with the decision and the impact it will have, it’s very important that you have a discussion with your doctor around the decision and completely understand the costs and benefits of all treatment options available to you.

It’s also important to recognise choosing not to travel for treatment may have a significant impact on your health and chances of survival.

Whether you feel uncomfortable talking about something so personal, or you’re unsure how your family and friends will react, sharing the news of a cancer diagnosis can often be hard.

Although you may want to protect the people you care about, telling them about your diagnosis can also bring people closer together. It’s completely up to you how much detail you share and when to share it, but it is unlikely that hiding your diagnosis will work. Sooner or later, your family, friends and surrounding community will find out that you have cancer.

By telling people yourself you can prevent misunderstandings, stay in control of the information that is shared and allow people to be there and support you. At times it may feel like nobody understands what you’re going through, but you can help them understand by talking about it.

You may also find that talking about cancer is not as difficult as you first thought—and by sharing the news, you will help ensure that you don’t have to go through cancer alone.

A cancer diagnosis can be an emotional time for you, your family, friends and community. It may leave you and those around you feeling upset, frightened and overwhelmed. These feelings can sometimes make it hard to understand and remember the information provided to you by health professionals.

You may experience strong emotions from when you first hear the words “you have cancer” and at any stage of your diagnosis.

If you or a loved one are feeling distressed following a cancer diagnosis, we encourage you to contact:

• Cancer Council SA on 13 11 20 for information and support, 9.00 am – 5.00 pm Monday to Friday (excluding Public Holidays).
• The Rural and Remote Mental Health Service on 13 14 65 at any time of the day or night. This service offers trained counselling and support from mental health experts to those in rural and remote communities impacted by cancer.
• Lifeline on 13 11 14 for 24-hour mental health support

When making decisions about your treatment, it is important to remember that there are a number of support services available that can support you when deciding how to get there and where to stay. Being well prepared can help reduce some of the worry and anxiety associated with treatment.

Cancer Care Coordinators/Patient Liaison Nurses may be available in your region to support you with navigating the medical system. Ask your GP or local health team about whether there are Cancer Care Coordinators or Patient Liaison Nurses in your local area.

Rural Liaison Nurses are registered nurses who work within metropolitan (Adelaide) hospitals to assist you with issues, such as accommodation and transport before and during your treatment. They can also help to make arrangements for you when you return home and are available on weekdays between 8.00 am – 4.00 pm, Monday to Friday. You could also ring them if you have any questions before, during or after your visit to the following public hospitals:

• Royal Adelaide Hospital : phone (08) 7074 0000
• The Queen Elizabeth Hospital : phone (08) 8222 6000
• Lyell McEwin Hospital : phone (08) 8182 9000
• Flinders Medical Centre : phone (08) 8201 5511
• Women’s and Children’s Hospital : phone (08) 8161 7000
• Social workers can help you deal with practical, financial and emotional issues, while you undergo treatment. Social work services are available to all public hospital patients and their families and friends to help them deal with the issues they face.

Depending on where you’re staying and/or receiving treatment, you may be able to access social workers by calling the numbers below:

• Flinders Medical Centre : phone (08) 8204 4144
• Lyell McEwin Hospital : phone (08) 8182 9100 and ask for the Duty Social Worker
• The Queen Elizabeth Hospital : phone (08) 8222 7250
• Royal Adelaide Hospital : phone (08) 7074 0000 and ask for the social work department
• Cancer Council Lodges : if you’re a guest at one of these facilities, speak to reception about organising a meeting with an onsite social worker. They will do their best to assist you with any financial, emotional or practical difficulties you are facing.

There are a number of things that you can do before you leave home for treatment to ensure you feel well prepared:

• Ask your local GP about the Patient Assistance Transport Scheme (PATS) and get them to fill in the form for you. You will find more information about the scheme and the relevant forms to download here .
• Ask your local GP if there is a Cancer Care Coordinator at your local health service who may be able to help you.
• Speak to your doctor if you’re having trouble sleeping or are in pain.
• If necessary, make arrangements for people to keep an eye on your house, pets, garden etc. while you are away.
• Download the app Gather my Crew to organise family, friends and community support.
• Let any groups or services that you’re involved with know that you will be away for a period of time (e.g. Meals on Wheels, paper delivery, local recreational clubs).
• Consider obtaining ambulance cover if you don’t have it already. If you’re medically required to be transferred home via road or air ambulance, it can be very costly without it. Phone the SA Ambulance Cover Customer Service Centre on 1300 136 272 to organise cover.
• If you have children, you may consider letting their school counsellor or classroom teacher know what is happening and offering them ideas about how they can support your child in the school environment.
• As well as writing down all of the medications you’re currently taking (including both prescription, non-prescription or alternative medicines), make some notes about your medical history, including any major prior illnesses or surgeries.
• If you feel well enough, consider doing some gentle exercise, such as walking. Only do as much as you can manage physically and mentally and remember this may be less physical activity than you’re used to.
• Eat a nutritious and balanced diet.

If you are travelling to Adelaide for treatment, it’s important to remember to bring the following with you to assist your health care team:

• X-rays/scans
• A list of current medications (including prescription, non-prescription or alternative medicines)
• Medication (including travel sickness pills, if necessary)
• Medicare, Pension, Health care, Veterans Affairs and Pharmaceutical Safety Net cards
• Photo identification, such as your driver’s license or passport. This is especially important if you’re travelling by bus or air
• A list of important phone numbers of your health professionals, family members and friends
• Money or debit/credit card
• Hospital admissions paperwork
• Patient Assistance Transport Scheme (PATS) form, completed by your local GP
• Private health insurance details
• Notes/letters/reports from your doctors
• Pyjamas/dressing gown/slippers
• Reading material, laptop, tablet/iPad
• Glasses and mobility aids (if required)
• Laundry powder (if you’re staying at one of the Cancer Council Lodges)

After a cancer diagnosis, many people worry about how they will manage the financial impact, especially if they have to travel to Adelaide for treatment. At the same time, a diagnosis may also mean taking time off work, or a loss of income for both you and your partner.

To help manage your financial security, we recommend exploring the following before you begin treatment:

• Speak to your employer or boss about taking leave, leave entitlements and flexible working arrangements (if applicable).
• Check whether you have Income Protection Insurance . This can be included in your superannuation policy. Find out whether it covers your situation and whether there is a waiting period before you can make a claim.
• Contact Centrelink to discuss your eligibility for financial support by phoning 13 27 17 or visiting www.humanservices.gov.au .
• Contact SA Health for information on the Patient Assistance Transport Scheme (PATS).
• Discuss your situation with your utility providers (e.g. gas, water, electricity), banks and other lenders. They can make allowances for people experiencing financial hardship by extending payment periods and deferring or reducing loan repayments.
• Obtain free financial advice by calling the National Debt Hotline on 1800 007 007 , 9.00 am – 5.00 pm for free financial advice.
• Visit the Money Smart website for a list of free financial counselling services.
• Head to the Medicare website or phone 13 20 11 for advice on what medical expenses are covered and how much you’ll be reimbursed for.
• Speak to a social worker in your treating hospital about your situation. They may be able to suggest financial assistance you may be eligible for.

If you are intending to enter the health system as a private patient, make sure you carefully examine your policy and ensure you’re covered for all aspects of your treatment. It’s important you understand all of the advantages and disadvantages of being admitted through the private system.

For more information click the below links:

• When cancer changes your financial plans
• Legal and financial assistance

A cancer diagnosis can raise several legal issues. For example, you may need to write or revise a Will, organise your Power of Attorney and deal with your superannuation, insurance, work and compensation. Dealing with these legal and financial issues can sometimes be overwhelming, but fortunately, support is available.

A useful place to start is to read Cancer Council SA’s Legal and Financial Assistance Guide. You can find it here .

You could also:

• Speak to your social worker about your legal concerns.
• Call Cancer Council SA on 13 11 20 for information about the Cancer Council SA Legal and Financial Referral Service.
• Head to the Legal Services Commission of South Australia website for online information about a range legal issues or phone the Legal Helpline on 1300 366 424 , 9.00 am – 4.00 pm Monday to Friday.
• Visit your local Community Legal Centres (CLCs). These are not for profit, non-government organisations that provide legal and welfare services. Offices are located in the following rural locations in or near South Australia: Berri (also covers Loxton, Renmark and Waikerie): Riverland Community Legal Service, phone (08) 8582 2255 or visit www.scjc.com.au . Broken Hill (also covers Wilcannia, Wentworth, Tibooburra, White Cliffs, Wanaaring and Ivanhoe): Far West Community Legal Centre, phone (08) 8088 2020 or 1800 300 036 or visit https://www.farwestclc.org.au/ Mildura : Murray Mallee Community Legal Service, phone 1800 243 002 or visit http://www.murraymalleelegal.com.au/ Mount Gambier (also covers Keith, Robe, Bordertown, Kingston, Naracoorte and Millicent): Limestone Coast Community Justice Centre, phone 1300 850 650 or visit https://www.communityjusticesa.org.au/
• Port Augusta (also covers Coober Pedy, Oodnadatta, Leigh Creek and Nepabunna): Legal Services Commission of SA – Port Augusta, phone (08) 8686 2200 or visit https://lsc.sa.gov.au/ . Women’s Legal Service (SA) – Outreach Service Port Augusta, phone (08) 8221 5553 or 1800 816 349 or visit http://wlssa.org.au/
• Port Pirie (also covers Clare, Kadina, Maitland, Peterborough and Port Augusta): Westside Community Lawyers Inc. phone (08) 8633 3600 or visit www.westsidelawyers.net

For further information and support, call 13 11 20 to speak to an experienced cancer nurse who can tailor information to meet your specific informational, emotional and practical needs.

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Travelling to treatment

Transport services.

 Travelling to treatment can be a challenge, even more so if your treatment centre is not close to home. There are travel services available to people affected by cancer in both metropolitan and regional areas.

Is it a good idea to ask your treatment centre if there are any transport services available to help you get to appointments. 

Help for people living in rural and regional areas 

If you are affected by cancer and live in regional and rural Victoria, you may be able to get help to pay for travel and accommodation you need in Melbourne as part of your diagnosis and treatment. This help comes from the Victorian Patient Transport Assistance Scheme (VPTAS). 

VPTAS is a government subsidy scheme that provides funding for some of the costs involved in travelling for specialist cancer treatment that you cannot access in your local area. 

Speak to the social workers at your hospital or treatment centre to get help from VPTAS. You can also call VPTAS directly on 1300 737 073 or visit their website for more information.

Visit VPTAS website

Questions to ask about this service

When looking at a service it is important to ask questions about how the service works before you decide to engage with them. Below is a list of questions you might like to ask when enquiring about a service.

Am I eligible?

Some services have specific criteria that a person must meet before they are able to use a service, for example location, means testing or a specific cancer type. It is important to know if you are eligible to access a service right from the start.

Do I need a referral?

Some services require a referral from your specialist, GP or a social worker. This helps to make sure that the right patients are being connected with the right services. It’s a good idea to ask if a referral is needed and if so, exactly what type of referral the service requires.

How much will this cost me?

Some services are free, and some come at a cost. At a time when people should be focused on their treatment and recovery, the cost of cancer can be a source of stress and worry for many. It’s a good idea to ask about the fees attached to a service and if there are any subsidies or benefits you might be eligible for before committing to the service. It’s important to know that you are within your rights to ask about the cost of a service or treatment before agreeing to take part. For more information you can visit cancer and your finances .

Is there a wait time?

Sometimes demand for a service is high which can cause wait times. You might find it helpful to ask if there are any wait times for the services you are looking at, especially if you require support as soon as possible.

What services do you offer?

Some organisations provide a range of services for people affected by cancer, their family, friends and carers. It is a good idea to ask about exactly what services are available to you.

Car parking 

There are many things you can do to reduce the costs and stress of parking. Prior to your visit:

• Ask the hospital about different parking options before your first visit. There may be onsite parking, street parking and private carparks near the hospital.
• Ask about parking rates prior to your visit and if any concessions are available. If you have a government concession card or are attending frequent appointments, you may be eligible for discounted car parking. Each hospital will have different concessions. Talk to your treatment team about how to access them.
• Allow enough time to find a car park and walk to your appointment.
• Ask how far the walk is from the parks to the hospital or use an online mapping tool like Google maps.
• Investigate public transport options available around the hospital. Speak with the hospital or call Public Transport Victoria on 1800 800 007 or visit www.ptv.vic.gov.au

More information

• Cancer and your finances
• Making decisions about your care
• Treatment information

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The inclusion of a service in this directory does not imply any endorsement of or association with that service by Cancer Council Victoria. It should not be considered exhaustive or taken as specific advice.

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Travel with metastatic breast cancer

Jump to section

• Domestic travel
• International travel and travel insurance
• International travel tips

Helpful resources

Things you can do now, topics in this article.

Want to learn more?

1800 500 258.

For some people, knowing they have metastatic breast cancer sparks a desire to fulfil lifelong dreams of travel. For others travel is a longer-term goal that people look forward to working towards. If you are thinking about travelling, you will have a few extra things to consider.  

Domestic travel  

If you are planning to travel within Australia, your doctors may be able to suggest options for medical support that make it easier for you to continue with your regular treatment, or simply provide some peace of mind.

If you are booking airfares that must be pre-paid, try to book a fare that is flexible in case you have to make last minute changes or delay your trip.

You may also want to check the cancellation policy of the accommodation that you are booking to make sure you can have as much leeway as possible should your travel plans need to change around your health. 

My husband says ‘let’s do that trip around Australia we’ve always talked about’ but I’m scared in case something happens. I need to be close to hospitals and family and all that support. But the thing is I’m well now and maybe we should be taking advantage of that.

International travel and travel insurance  

International travel is more complicated because you’re not covered by Medicare once you leave the country, and it is unlikely that your private health insurance will help with any medical costs.

Reciprocal health care

Australia has reciprocal health care agreements (RHCAs) with New Zealand, United Kingdom, Republic of Ireland, Italy, Belgium, Finland, Netherlands, Norway, Sweden, Slovenia, and Malta.

When you’re travelling in these countries any medical care you need will be covered by the local public health system, to varying degrees. For more information about reciprocal health care agreements, see  Services Australia .  

After all the hassle of getting the drugs organised, doctors’ letters and trying to organise the insurance that I couldn’t get anyway, I finally went overseas. I didn’t have one day of illness. Why did it take me six months to do that trip? It’s the uncertainty, isn’t it? And we are all living with that.

Most international travellers take out travel insurance to cover things like lost luggage, accidents and medical cover. There are some travel insurance policies that will cover you for these incidentals but unfortunately you are unlikely to be able to obtain cover for medical costs related to your cancer. This is because it is viewed as a ‘pre-existing condition’.

Sometimes people decide to travel without insurance to countries that don’t have a reciprocal agreement. This is a personal decision, and for many people, it is a matter of weighing up the risk of needing medical attention against the possible cost.

Some travel insurance companies may be more flexible about covering people with breast cancer. You may need to consult a travel agent or specialist travel insurance consultant to find out what is available.  

International travel tips  

If you are planning an overseas trip, talk with your medical oncologist before you make any payments. It may be better to hold off making payments on a trip until as late as you can.

When travelling overseas, make sure you take a letter from your oncologist detailing any medications you are carrying and the reasons you have them and keep your medications in their original packaging. It is also important to ensure you have enough of your prescription medication to cover you for the entire time you are away.

Ask your oncologist to also provide you with a brief summary of your breast cancer history, and treatments you have had in the past. Store this information somewhere safe when you travel and leave a copy with family or friends back home.

Check in with your oncologist or GP just before you travel and make sure you act on any symptoms that are suddenly new, before you head away.

Travelling overseas can be complicated but with some forward planning you can reduce your risks of having an experience that leads to trouble when you are away.  

My family have allowed me the dignity of risk. I have just returned from travelling overseas with the encouragement of my oncologist, but without insurance.

I had really wanted to travel to the USA but when I realised I wouldn’t be covered for hospital costs I just wasn’t prepared to take that risk.

I know that when I decided to go ahead with our trip, the fact that I was able to access medical care in the United Kingdom was one of the things that helped me decide to go. As it turned out I did need treatment while I was away. I did not have to pay a cent for this treatment or medication and I was treated with the utmost care and consideration. The small hiccup of my stay in an Edinburgh hospital pales into insignificance when compared with the memories of our time in Europe and the UK, which will stay with us for the rest of our lives.

Compare Travel Insurance (1300 659 411)

This company provides comparative quotes and detailed information on a range of insurance providers for overseas travel, including insurance providers that may offer some degree of cover for people with cancer.

OTIS Foundation (03 5444 1184)

The OTIS Foundation offers retreats in selected locations, available free of charge for people with breast cancer, and their families. Located in Victoria, NSW, NT Qld, SA and Tasmania, they offer a place to take time out to relax, contemplate and regroup. Each retreat is located in a beautiful environment, allowing guests to draw on nature for strength and comfort.

Corporate Angel Network of Australia

The Corporate Angel Network of Australia includes corporations and individuals in hospitals, cancer and leukaemia support groups, aviation companies and businesses who work together to assist patients affected by cancer, and their families.

• Read BCNA’s fact sheet  Travel insurance with metastatic breast cancer  

Visit My Journey , BCNA’s online tool for information tailored to your diagnosis. 

Join our Online Network  if you think that talking to others online and sharing experiences will help.  

Contact BCNA’s Helpline on 1800 500 258 between 9.00 am and 5.00 pm AEST Monday to Friday, for information about the services and support that may be available for you and your family. 

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Travel and holidays

Top travel tips for people with blood cancer

Many people affected by a blood cancer think that they’ll be unable to continue many of the activities they enjoyed prior to diagnosis, like travelling.

While travel isn’t advisable for some treatment plans and conditions, it can be possible with a little extra planning and by taking some factors into consideration.

You may find the below tips useful for before and during your trip. Remember, you must always talk to your doctor first if you are considering any type of travel.

Before your trip

• Research your medications. Make sure that the drugs you are taking with you are not controlled substances in the countries you are visiting, as there may be restrictions on what and how much you can travel with. Make sure you have enough medication to cover your trip.
• Take a doctor’s note with you. Ask your doctor for a letter outlining the details of your condition, your treatment history, and a list of medications.
• Check your vaccinations. Ask your doctor if your vaccinations are up to date, and see if you need to get inoculated (e.g. hepatitis, typhoid, tetanus). You will need to avoid any live vaccines for the six months following chemotherapy .
• Research travel insurance. It can be difficult to find a travel insurance company that will cover a pre-existing condition like blood cancer. However, there are some companies that will cover you depending on your general health, your blood counts and where you are at in your treatment plan. Otherwise, you can get travel insurance through a multitude of companies to cover other complications that aren’t related to your cancer – for example, if your flight gets delayed, or if the airline loses your luggage.
• Talk to your doctor about your plans. Find out if, when, and where you can travel, and what precautions you need to take. Don’t get discouraged if they advise you against going abroad just yet; you may be able to take a mini break interstate instead.

During your trip

• Get moving! If you’re going to be sitting for long periods of time, you should take some measures to prevent blood clots. Some people with a blood cancer have an increased risk of developing blood clots, as they may have a high level of the proteins and platelets that help the blood to clot. Take short walks as often as possible; do simple leg exercises if you can’t leave your seat too much; wear compression stockings; and have plenty of non-alcoholic drinks.
• Be sun safe. Your skin may be more sensitive and drier after treatment, so protecting it from the elements is important. Wear sunscreen, loose cotton clothing, and a hat.
• Keep up good hygiene practices. Some people are at a higher risk of infection after treatment, plus illnesses like gastro and the flu can ruin even the healthiest person’s holiday! Proper hand washing, eating food that has been properly and freshly cooked, and (in certain countries) drinking bottled water are all easy measures you can take to minimise your risk.

It can be very uplifting to focus on a future holiday while you’re having treatment. Work with your treatment team and take a few simple precautions to ensure you look after yourself while you’re away.

Last updated on June 19th, 2019

Developed by the Leukaemia Foundation in consultation with people living with a blood cancer, Leukaemia Foundation support staff, haematology nursing staff and/or Australian clinical haematologists. This content is provided for information purposes only and we urge you to always seek advice from a registered health care professional for diagnosis, treatment and answers to your medical questions, including the suitability of a particular therapy, service, product or treatment in your circumstances. The Leukaemia Foundation shall not bear any liability for any person relying on the materials contained on this website.

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Travelling to your healthcare appointment

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• Living in a regional or remote areas can mean that access to medical treatment is more challenging, as you might need to travel long distances.
• Planning ahead can help to reduce the cost of long distance travel.
• Patient assisted travel schemes (PATS) are available in each state or territory to help rural and remote community members access necessary and approved medical specialist services that are not locally available.
• Private health insurers offer travel and accommodation benefits under hospital cover, but not all health funds offer these benefits.
• Telehealth and other technologies can help reduce the need to travel in some situations.

How can I plan ahead?

If you live in rural or remote Australia, your treatment options may be limited and getting medical treatment may mean travelling long distances. This can be complicated and costly.

If you work, go to school or have other regular commitments, let your manager or teacher know you will be away. They may need to find someone to cover you while you're away.

If you care for a child or someone else, you may need to arrange for their care while you are away. You may also need to continue this extra support after your return, while you recover.

For routine household tasks, ask a friend, neighbour or family member to help:

• look after your pets or plants
• collect your mail
• pay your bills for you

Remember to take everything you need to your appointment. This includes admission forms, details of medicines or dietary supplements you are taking, test results, x-rays, scans, or medical reports.

What should I consider before I travel?

You may need to access extra support and services for your travel, stay and recovery. Before you travel, you should consider the following:

• Am I okay to travel alone?
• Will I need a carer or support person?
• What forms do I need to be signed by my medical team before I go?
• Will I need extra help on my trip home?
• What are my access requirements? Will my travel choices and accommodation suit my needs before and after my medical treatment? This may include: The width of the hallway, room dimensions including bathroom, height of the bed and available parking.
• Can my transport provider accommodate any equipment I need, such as a wheelchair or walking aid?

Tips from rural community members when travelling for healthcare

• Try to organise several appointments for one trip.
• If possible, make appointments at a time that suit your family and work needs.
• If you're not feeling well or if there is a possibility of receiving unwelcome news, ask a friend to drive, or consider staying overnight if you need to drive yourself.
• Take pillows to rest your arm or head in the car/plane/bus.
• Contact a support group or person near your treating hospital or clinic.

What should I consider after I travel?

Learning as much as possible about your recovery can help you to prepare what you will need after your treatment. Ask your doctor about your recovery time and what support is available. You might be eligible for home support services, depending on your state, age and health.

Read more about care options here:

• My Aged Care
• Carer Gateway
• What care do I need?

If you are living with a specific health condition or disability, you may be able to get more detailed information online or from local groups or associations. For example, the Breast Cancer Network Australia offers support in rural areas , and provides online video communication with home when travelling for treatment, through the stay in touch program .

Financial assistance for travel for healthcare

Accommodation and travel expenses can be costly. You may be eligible for help to ease this financial burden.

Patient Assisted Travel Schemes (PATS)

All states and territories have Patient Assisted Travel Schemes (PATS) to help eligible patients in rural and remote Australia with the costs of travel These can help you access specialist medical services not available locally.

Rules and amounts vary, but all PATS schemes help cover:

• travel expenses for public transport
• accommodation costs at your destination
• travel expenses and accommodation costs of your eligible support person or carer

Some schemes also cover some costs of:

• ground transport costs at your destination (for example, taxis)
• living away from home
• accommodation
• costs for trips by private car
• extra journeys for your support person or carer, if your stay is long
• subsidies for private accommodation

Read about PATS support in your state or territory:

• ACT: Interstate Patient Travel Assistance Scheme
• Northern Territory: Patient Assistance Travel Scheme
• NSW: Isolated Patients Travel and Accommodation Assistance Scheme
• Queensland: Patient Travel Subsidy Scheme
• South Australia: Patient Assistance Transport Scheme
• Tasmania: Patient Travel Assistance Scheme
• Western Australia: Patient Assisted Travel Scheme and Interstate Patient Travel Scheme
• Victoria: Victorian Patient Transport Assistance Scheme

Private health insurance

Private health insurers now offer travel and accommodation benefits under hospital cover. These private health insurance benefits generally cover:

• petrol costs for travel by car
• train, bus or air fares
• accommodation costs near the place of treatment for the patient and a carer

Not all health funds offer these benefits. If you have a health fund, check your policy to see what is included. Be aware that cover varies between health funds and policies.

Other support services

The following organisations may offer help with travel for healthcare:

• Australian Red Cross
• Angel Flight Australia
• Royal Flying Doctor Service
• Department of Veterans' Affairs

These organisations provide help with accommodation:

• Ronald McDonald House
• Country Women's Association

Read more here about rural and remote health services and support.

What options do I have if I prefer not to travel?

You might be able to avoid travelling for medical treatment or care, thanks to technology and advances in healthcare delivery.

Telehealth services

Telehealth services use video conferencing technology. This means you can talk with a healthcare professional via your computer, tablet or phone and see their image on the screen.

Your doctor might ask your permission to record video, audio or other health information. They can then forward it securely to other medical specialists, who can review it and provide an opinion. Telehealth services can also be used to remotely monitor patients, if required.

Telehealth services save travel time and costs. They can be a less stressful option than travelling a long distance for healthcare. Medicare benefits are often available — check with your health team if they offer telehealth, and if it is right in your situation.

Video Call , developed by Healthdirect Australia, allows healthcare providers to have video consultations, using your smartphone, tablet or desktop computer. This private and secure service connects you with your healthcare professional from a location convenient to you, such as your home or work.

Telehealth services can also be a convenient way for carers or translators or interpreters to be involved in healthcare conversations.

If your doctor or medical centre doesn't offer telehealth consultations, you can use the healthdirect service finder to find a provider.

Depending on your needs, ask your healthcare team if you can:

• reduce the number of appointments that require travel
• use your local health service more, instead of travelling for treatment
• access any outreach services in your area

Resources and Support

See healthdirect's online Question Builder for help putting together a list of questions for your health team. If you have a long or difficult journey to reach your doctor, it is especially important to be well prepared, so you can make the most of your visit.

Read more about healthcare options and Australia's healthcare system.

Look for specific rural and remote health services for your state or territory:

• New South Wales rural and remote health services
• Northern Territory rural and remote health services
• Queensland rural and remote health services
• South Australia rural and remote health services
• Tasmania rural and remote health services
• Victoria rural and remote health services
• Western Australia rural and remote health services

Learn more here about the development and quality assurance of healthdirect content .

Last reviewed: July 2023

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Rumors of King Charles Touring Australia amid Cancer Re-Emerge as Source Says Nothing Has Been Ruled Out

T he King's nephew recently shared that the monarch is "hugely frustrated" that he "do everything that he wants to be able to do" amid cancer treatment

King Charles ' first trip Down Under as monarch is still up in the air amid his cancer treatment .

After Australian Prime Minister Anthony Albanese said last month that the country is "preparing for a possible visit from His Majesty The King to Australia later this year," new reports say the King, 75, is prepping for the visit to occur this fall.

A royal source guides that nothing has been ruled out or in as they look ahead to the fall and planning continues for future engagements, but it is all subject to medical advice and there may be adaptations where necessary at the time. Overseas visits would not and could not be confirmed until nearer the time.

Before news of his cancer diagnosis, King Charles was widely expected to travel to Australia around the time of the Commonwealth Heads of Government Meeting (CHOGM), which is being held in Samoa and scheduled to kick off on Oct. 24. Since Australia is a Commonwealth realm, they recognize the British monarch as their head of state.

"The King has shown his compassion for Australians affected by recent natural disasters, just as Australians have shown compassion and support for the King following his cancer diagnosis," Albanese said last month. "The King, Queen and members of the royal family are always welcome in Australia. My government is engaging with states and territories on options for a possible royal visit."

Related: King Charles Receives Well-Wishes for Kate Middleton on Easter as They Both Undergo Cancer Treatment

A royal source recently told PEOPLE that the monarch and his team are thinking about a summer schedule amid "amplified confidence" in light of the sophisticated cancer treatment he is receiving, adding that the King is "positive" and his doctors "are optimistic."

While he's continued to work behind the scenes, King Charles' royal engagements have been restricted to small numbers of people since the palace  revealed his cancer diagnosis  on Feb. 5, However, towards the summer when the risk of airborne illnesses eases, larger events could take place outside – such as  Trooping the Colour , the annual public celebration of the monarch's birthday set for June 15 this year.

"One thing that has been wholly undiminished is his appetite for work," the royal source added.

Can't get enough of PEOPLE's Royals coverage?  Sign up for our free Royals newsletter  to get the latest updates on Kate Middleton, Meghan Markle and more!

Peter Phillips , the King's nephew, recently said the monarch is "very keen to get back to a form of normality."

“I think, ultimately, he's hugely frustrated . He's frustrated that he can't get on and do everything that he wants to be able to do," Princess Anne's son said on Sky News Australia 's  The   Royal Report. “But he is very pragmatic, [and] he understands that there's a period of time that he really needs to focus on himself."

Related: Kate Middleton and King Charles Bond amid Cancer Diagnoses: 'The Daughter He Never Had' (Exclusive)

In a promising sign of his progress, King Charles made his first major public appearance since his cancer news on Easter to attend church with members of the royal family. After the mass at St. George's Chapel in Windsor Castle, the monarch and  Queen Camilla  briefly  greeted members of the public on a surprise walkabout.

"Get well soon, Your Majesty," a woman said in a video shared to  X  by Rebecca English of the  Daily Mail , prompting the King to reply, " I'm doing my best! "

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American Airlines has multiple travel advisors up in arms after it announced plans to restrict AAdvantage Miles earnings for certain booking agencies.

The airline behemoth  announced  in February that flyers hoping to earn AAdvantage miles for their flights will have to do so directly through American, their airline partners, or preferred travel agencies recognized by the company.

The change will take effect on May 1, but American has yet to reveal which agencies will be included in its “preferred agencies.”

The change comes as part of the airline’s effort to minimize costs for agencies using older technology booking systems.

The airline has tried to convince agencies using the older booking systems to upgrade to newer platforms like the one American uses on its website.

While American  announced  a list would be shared in “late April,” agencies unsure if they’ll make the cut are expressing their distaste for the major change.

The American Society of Travel Agents (ASTA), Association of Canadian Travel Agencies and Advisors (ACTA), Foro Latinoamericano de Turismo (FOLATUR), and World Travel Agents Associations Alliance (WTAA) emphasized that any plans to restrict their clients’ earning miles could be detrimental to their agencies.

“It’s clear from the consensus among WTAAA, ACTA and FOLATUR, representing travel professionals around the world, the detriment that American’s decision will have on the travel industry globally,” President and CEO of ASTA, Zane Kerby, told  Travel and Tour World .

Kerby called out American for “operating in bad faith” and was “looking to pad its bottom line at the expense of our valued clients and the millions of consumers who rely on their trusted travel advisor.”

Henry Harteveldt, president of the travel industry market research firm Atmosphere Research Group, told  Fodor’s Travel  the move is a “very inward-looking” perspective on American Airlines.

“It’s not a very consumer-friendly approach, and American is being a bit of a bully here,” Harteveldt explained — adding the move will put loyalty airline members in the crossfire of the company’s dispute with agencies.

Harteveldt believes the move is also being monitored by the company’s competitors, who may adopt the change if it’s a success or whose sales teams may swoop in to poach any American flyers unpleased with the new method.

“As risky as American’s actions are, a lot of airlines are watching to see if it works out well for them, because if it does, I would not be surprised to see United and Delta copy it in certain ways,” he told the outlet.

While the airline is deadset on the change, Brett Snyder — author of the popular travel industry blog Crankyflier and CEO of the travel assistance service Cranky Concierge — said the move could cause “confusion” for the company’s flyers who already are trying to navigate their “frequent changes.”

“The biggest impact will likely be on business travelers who may not have a choice of where to book depending upon company policy,” Snyder told the outlet.

“The fact that American still hasn’t told everyone who is or is not preferred adds more to the confusion.”

As the airline industry waits to hear who American will list as their “preferred agencies,” occasional travelers may also feel the weight of the change, Snyder explained.

He worries that some agencies may not disclose that to their customers during the booking process.

Also, the move could affect cruise lines that book airfares as part of their packages, who may opt against using certain agencies not listed as one of American’s preferred agencies.

The changes will only affect travelers who collect AAdvantage Miles for their flights on American.

Flyers using corporate accounts with American will continue to earn miles for their flights no matter which booking channel they use unless they book a Basic Economy fare.

Travelers collecting miles from other Oneworld partners—the global airline alliance American is a member of with 13 other Airlines, such as British Airways, Qatar Airways, and Malaysia Airlines—will continue to earn miles for American Airlines flights regardless of booking channel.

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Traveling With Cancer: A Guide for Oncologists in the Modern World

Sharon heng.

1 Monserrat North Lakes Day Hospital, North Lakes, QLD, Australia

Brett Hughes

2 Royal Brisbane and Women’s Hospital, Herston, QLD, Australia

Michael Hibbert

3 Royal North Shore Hospital, St Leonards, NSW, Australia

Mustafa Khasraw

Zarnie lwin.

Travel for patients with cancer has become more achievable because of gains in quality of life and overall survival. The risk assessment of these patients is complex, and there is a paucity of data to which clinicians can refer. We present the challenges of traveling with cancer and a review of the literature.

A review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A search using the terms ”cancer,” “advanced cancer,” ”metastases,” “brain edema,” “lymphoedema,” “pneumothorax,” ”pleural effusion,” “pericardial effusion,” pneumonitis,” “hypoxia,” “end-of-life,” and “shunt,” combined with “flying” and “air travel,” was conducted. The PubMed and Cochrane databases were searched for English-language studies up to December 2018. Studies, case reports, or guidelines referring to travel in the context of adult patients with malignancies were included. A total of 745 published articles were identified; 16 studies were included. An inclusive approach to data extraction was used.

There were no specific criteria to deem a patient with cancer fit to travel. Neurologic, respiratory, and cardiac implications, and time from recent surgery or procedure need to be considered There was a lack of high-quality studies to inform decisions, but the British Thoracic Society and Aerospace Medical Association Medical Guidelines included recommendations for fitness to fly for patients with cancer.

In the absence of large prospective studies, individual fitness to travel should be assessed on a case-by-case basis, bearing in mind that maximizing a patient’s ability to safely travel is an important goal for many individuals with cancer.

INTRODUCTION

In 2018, global air traffic passenger revenues increased to $561 billion (an increase of 7.6%) compared with 2017. 1 The growing number of people traveling by air has conspicuously made inflight medical emergencies more common. 2 , 3 Traveling in general, and especially airplane travel, is a major source of stress with health risks, particularly in the context of a preexisting illness such as cancer. 4 , 5

Whether it is to visit overseas relatives or friends, tick off special destinations of interest on a bucket list, or seek out therapies not available in their own countries, patients with cancer often contemplate travel. The past decade has seen a changing landscape in cancer survivorship and lifestyle for patients and carers alike. 6 These improvements are the result of earlier detection and new effective therapies. Small-molecule oral targeted agents, immuno-oncology, and targeted radiation techniques are reshaping cancer care throughout the entire disease trajectory. Newer therapies not only permit better performance status but also afford better progression-free and overall survival. 7

In addition, consumer awareness is steadily changing. Social media platforms enable consumers to connect and gain information about the latest treatments and clinical trials nationally or internationally. 8 , 9

These advances may translate to patients contemplating travel, including air travel, for medical reasons, such as for second opinions, for treatment at their cancer center of choice, or to explore trial opportunities. Others may do so for personal reasons. In some cultures, it is meaningful for patients to die in their homeland, necessitating travel in the (pre)terminal phase.

For the oncology multidisciplinary team members providing care, the risk assessment of air travel in particular is a complex problem posed in the daily clinical setting. Factors to consider include, but are not limited to, the patient’s physical capabilities, the distances involved, and the country of destination. 10 Although commercial airlines routinely specify that anyone with a terminal or serious illness requires medical clearance 11 , 12 there is a paucity of data or guidelines for clinicians to certify fitness to fly. We present the challenges of traveling with cancer, with a specific focus on air travel and a review of the scientific literature, which we examined to critically evaluate the current data on this topic.

• Key Objective
• Do oncologists have data to guide them in assessing whether patients with cancer are fit to fly? The current evidence on traveling with cancer, with a specific focus on air travel, was collated, critically evaluated, and summarized in a narrative review.
• Knowledge Generated
• Only sixteen published articles were found relevant to traveling among patients with cancer, with no specific criteria found to guide the oncology community in assessing the risks of air travel and no randomized studies performed. However, the British Thoracic Society and Aerospace Medical Association Medical Guidelines had useful recommendations for fitness to fly among patients with cancer.
• In the absence of high-quality studies, individual fitness to travel should be assessed on a case-by-case basis, using existing recommendations as a guide.

SEARCH METHODS

A review using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was performed. A search using the terms “cancer,” “advanced cancer,” “metastases,” “brain edema,” “lymphoedema,” “pneumothorax,” “pleural effusion,” “pericardial effusion,” “pneumonitis,” “hypoxia,” “end-of-life,” and “shunt,” combined with “flying” and “air travel,” was conducted. These search terms were selected because they were conditions most likely to be associated with malignancy and its treatment. The PubMed and Cochrane databases were searched for English-language studies up to December 2018. The retrieved studies were screened and reviewed for relevance. Studies, case reports, or guidelines referring to travel in the context of adult patients with malignancies were included. Airline and transport organization guidelines were hand searched and reviewed for relevance. A total of 745 published articles were identified; 16 studies were included. Because of the paucity of literature, we used an inclusive approach to data extraction. All eligible data were included to avoid omitting findings of potential value.

Sixteen published articles were found relevant to our topic. We graded the studies according to the grading system listed in Table 1 . We categorized the findings from these studies into pretravel, during travel, and post-travel issues. Table 2 lists the studies ranked on the basis of the level of evidence.

Grading System to Categorize Studies on the Basis of Their Clinical Value

Included Studies of Travel in Patients With Malignancy

“Doctor, Am I Fit to Fly?”

There are no specific criteria to deem a patient with cancer fit to fly. As a general rule, patients who are clinically unstable, currently receiving intensive radiation or systemic treatment protocols, or are terminal should not attempt commercial air travel. 4 Clinical instability combined with the stresses of flight could pose a serious threat to the patient, 4 not to mention the difficulty in obtaining medical care or emergent medical interventions midflight.

Neurologic implications.

Patients with primary brain tumors or brain metastases..

The emergence of local and more effective systemic treatments has rendered brain metastases as one of the new frontiers in cancer survivorship. 28 , 29 Patients with treated brain metastases may not only enjoy a good quality of life, but also have new opportunities to participate in clinical trials in select tumor streams. 29 Hence, it is not uncommon for patients with known cerebral disease to plan travels, including overseas.

There are no specific airline policies or regulations regarding patients with primary brain tumors or cerebral metastases. The effects of air travel on intracranial pressure warrant additional investigation, 30 but studies in such circumstances are difficult to perform. The biggest study published was a case series of 63 patients with brain tumors traveling via commercial airlines for surgery. The authors found that most patients with brain and skull base tumors can travel safely via commercial airlines with acceptable symptom exacerbation. However, they cautioned that corticosteroids and anticonvulsants should be considered in patients who are symptomatic or have relatively large tumors with mass effect and peritumoral edema. 24 Although cerebral disease should not be affected by reduced pressure, moderate hypoxemia at a high altitude could theoretically lower an already reduced seizure threshold. 31 Oxygen delivery may be decreased in patients who are elderly, are volume depleted, are anemic, or have significant cardiopulmonary disease. 4 Patients with seizures should also be made aware of other potential seizure-lowering threshold effects of fatigue, delayed meals, alcohol intake, or disturbed circadian rhythm on long flights. 4

Recent neurosurgery.

There is a lack of evidence on when a patient can fly after neurosurgery. 32 Any neurosurgical procedure may cause seizures, ischemia, and inflammation. 33 Endoscopic intracranial surgery has less retraction injury to the adjacent normal brain, but all the risks of open surgery are still present, although relatively less. 32 If intracranial air is present postcraniotomy, it will be reabsorbed over weeks. Gas trapped within the skull will cause increased intracranial pressure when it expands at high altitudes, but it is not known at which level of pneumocephalus and at which starting intracranial pressure complications would develop. 34 Patients should have a computed tomography head scan for evidence that any intracranial gas has been absorbed. 4 Flying should be considered contraindicated if there is any residual air within the cranial cavity. 11,12 Cerebral spinal fluid leaks from any cause also raise the possibility of backflow and microbial contamination. 4

Cardiothoracic implications.

Respiratory symptoms..

Patients who have undergone a recent pneumonectomy or lobectomy have reduced pulmonary reserve that may only become apparent during flight. 4 The British Thoracic Society guidelines suggest that patients with significant respiratory symptoms, comorbidities exacerbated by hypoxemia, recent pneumothorax, risk of or previous venous thromboembolism, and a preexisting requirement for oxygen should be assessed for fitness to fly, including referral to a respiratory physician and possibly a hypoxic challenge test. 31 The purpose of a hypoxic challenge test is to determine the need for inflight oxygen by exposing the patient to the hypoxia experienced at a cabin altitude of 8,000 feet while measuring hypoxemia and assessing symptoms. This is simulated using a mixture containing 15% oxygen, which the patient breathes for 20 minutes. If the arterial oxygen pressure is less than 6.6 kPa (< 50 mmHg) or blood oxygen saturation is less than 85%, inflight oxygen is required. 35

Patients with a usual oxygen requirement flow rate exceeding 4 L/min at sea level will experience respiratory decompensation inflight. Hence, air travel is contraindicated. 31 Those with symptomatic lymphangitis carcinomatosa, especially if the patient’s arterial oxygen pressure and respiratory function are compromised, or superior vena cava obstruction should only fly if absolutely essential, and they should have inflight oxygen available. 31 Patients with major hemoptysis are at risk for exacerbation and should be cautioned against flying. 31

Large pleural effusions should be drained at least 14 days before the flight, with post-thoracocentesis chest imaging to assess pleural fluid reaccumulation or for pneumothorax. 4 It is recommended that patients with a current closed pneumothorax should not travel on a commercial aircraft, whereas those with a previous pneumothorax will need a chest x-ray confirming resolution before traveling. 31

Malignant pericardial effusion.

No literature was found regarding flying in the setting of a malignant pericardial effusion. Theoretical concerns of cardiac tamponade and circulatory collapse should be considered in the context of the size of the pericardial effusion and the patient’s malignancy.

Implications of abdominal surgery and abdominal complications.

Aerospace Medical Association guidelines recommend delaying air travel for 7 to 14 days after major surgical procedures. 4 Because of the occurrence of relative ileus for several days postsurgery, there is an increased risk of suture line tears, bleeding, and perforation. 4 . Laparoscopic abdominal surgical procedures are less associated with ileus than open procedures and are not as restrictive. Flights can occur the next day if bloating symptoms are absent. 4 Patients with bowel obstruction or diverticulitis are advised to wait 7 to 10 days after resolution before air travel. 4

Implications of postoperative lymphedema.

The precipitating factors for lymphedema postsurgery/postirradiation are uncertain, but may include pressure changes resulting from airplane travel. 27 Only a single study has shown a significant correlation between air travel and lymphedema in a small number of patients. 25 Although one study reported that air travel of less than a 4.5-hour duration represented a low risk for lymphedema, 20 others reported that air travel did not increase lymphedema risk. 14 - 16 , 21 , 22 A systematic review found that air travel was not adversely associated with the development of lymphedema after breast cancer surgery. 13

Implications of thromboembolism.

In the setting of a deep vein thrombosis (DVT) or pulmonary embolism, airlines mandate medical clearance within 21 days of the event, and patients need to be stable while taking anticoagulants, with normal respiratory function before being allowed to fly. 11,12 In fact, it is recommended that patients who have had a recent DVT should not fly for 4 weeks or until the DVT has been treated and there is no evidence of pre-exercise or postexercise desaturation. 31

Implications of travel in the context of clinical trials.

Meticulous planning is required if patients require travel while participating in a clinical trial. Organizing travel logistics, such as cost, medication supply, monitoring adverse effects, and ensuring strict adherence to treatment protocol, will vary.

“What Do I Need to Prepare Before I Go?”

Medications and vaccinations..

An adequate supply of oral cancer medications, as well as supportive medications such as antinausea, antidiarrheal, analgesic, and other medications that might help with symptom control, will need to be provided to patients. Restrictions on the quantity of medications such as opioids and supportive documentation should also be considered, particularly when visiting countries with different legal consideration for the possession of restricted medications. When traveling to different time zones, also consider that disruption in daily routine can cause confusion concerning timing of medications. 5

Travel physician advice on vaccinations on the basis of the intended travel destination can be helpful because the immunocompromised host is less responsive to vaccinations, and protective levels of vaccines may be of shorter duration. Studies are lacking to evaluate the response to travel-related vaccines in immunocompromised patients with cancer or stem-cell transplantation recipients. 18 , 23 Thus, specific guidelines for these groups are absent. 23 Complete recovery of the immune system may take up to a year in patients treated with lymphocyte-depleting agents, thus increasing the risk of opportunistic infections and precluding the use of live vaccines. 23 . To optimize the immunologic response, immunocompromised hosts should be vaccinated during periods of no or low exogenous immunosuppression when possible. 18 Vaccination for travel should be started several months before the trip to allow time for serologic evaluation with possible additional boosters. 18

Biochemistry.

There were no published data to indicate the minimum hemoglobin level at which it would be safe to fly, but major airlines recommend a level of 8.5 g/dL or more. 31 Electrolyte imbalances should be corrected where possible and travel avoided if the patient is symptomatic or unstable. 31

Respiratory function.

Sea-level oxygen saturation poorly identifies those at risk who will desaturate to below 90% during routine commercial flights. 37 One third of patients with a sea-level blood oxygen saturation of 92% to 95% but no other risk factor desaturated below 90% during a hypoxic challenge. 37 However, hypoxic challenge might not be necessary in patients whose oxygen saturation is at or above 95%. No consensus exists regarding assessment methods or criteria for recommending oxygen. 38 A hypoxic challenge test could assist in determining suitability for flight and need for supplemental oxygen inflight. If supplemental oxygen is required, medical clearance is essential. 11

Venous thromboembolism.

Patients with active malignancy are considered at high risk for venous thromboembolism (VTE), and the risk of VTE is greatest on flights lasting more than 8 hours. 31 A Cochrane review found that airline passengers could expect a substantial reduction in the incidence of symptomless DVT if they wore compression stockings on flights longer than 5 hours. 41 A preflight prophylaxis dose of low molecular weight heparin for both outbound and inbound journeys should be considered, in addition to other general recommendations, such as avoiding excess alcohol and caffeine-containing drinks, maintaining adequate hydration during the flight, remaining mobile, performing inflight exercises wearing compression stockings, and avoiding the use of sedatives. 31 Aspirin alone is not recommended. 52

Postoperative lymphedema.

No consensus exists with reference to the risk conferred by air travel on the development of lymphedema and the utility of compression garments as prophylaxis on flights. 17 One study called into doubt the safety and efficacy of compression garments and noted that should a compression garment be worn, it is to be checked carefully near the time of the flight for the correct fit. 20 The position statement of the National Lymphedema Network recommends the use of compression garments during air travel for people with a confirmed diagnosis of lymphedema. 40 Specifically for breast cancer, there is no evidence to show that prophylactic compression sleeve use is or is not of benefit 17 .

Physical logistics.

A considerable amount of physical activity is also involved in travel, much of it carrying, pushing, or pulling bags, which may well be in excess of the passenger’s normal exercise limits. Most airports provide excellent services to assist the disabled passenger, and arrangements should be made beforehand, if possible. 5

Medical clearance.

Medical clearance forms vary among airlines, but information is generally available on the respective airline Web sites. Commonly, medical clearance is required when traveling within a certain period of time after a medical event. 11,12

Travel insurance.

For international travel, some travel insurers may cover cancer-related costs in select circumstances, for example, prolonged periods of controlled disease or not having required treatment within a certain time period. However, most patients with active cancer or receiving treatment will find it difficult to obtain any travel health insurance cover. Even if provided, the patient may be charged an assessment fee or a higher premium. 42 Patients need to be made aware of out-of-pocket expenses in the setting of unexpected hospital presentations, emergency procedures, and need for repatriation because often these costs may be high, depending on the countries involved. The level of medical capability will also vary among countries, and patients should consider what, if any, care they may require when abroad and whether these needs can be met, should they require it.

Other documents.

A written summary of the patient’s cancer treatment should be provided by the physician to the patient, including diagnosis, treatment, and contact details of treating physicians and family members. It would also be useful to have results of prior investigations, such as chest x-rays, computed tomography scans, or other abnormal tests. This information should ideally also be translated into the language of the country of destination. 10 Patients should also ensure that their wills and advanced health directives are updated.

“What Kind of Problems Can I Get Into During the Flight?”

Air cabin pressures..

Although modern aircraft cabins are pressurized, cabin air pressure at cruising altitude is lower than air pressure at sea level. As airplanes ascend, the cabin pressure is maintained at a level that corresponds to the outside air pressure at 6,000 to 8,000 feet above sea level, depending on the route and type of aircraft. This correlates to oxygen concentrations of approximately 15.1% to 17.1%, 43 which results in an estimated blood oxygen saturation of 90%. 4 Blood oxygen levels may drop by an average of 5% at cruising altitudes on both short- and long-haul flights. 44 Newer aircrafts, such as the Boeing Dreamliner, are able to maintain cabin air pressure at not more than 6,000 feet, which correlates to a smaller drop in blood oxygen levels.

Cabin air undergoes a degree of recycling, as well as exchange with atmospheric air. This process leads to increased inspired fraction of carbon dioxide levels in aircraft cabins during flight. A mild degree of hypercapnia can lead to cerebral vasodilation, 43 which in turn raises intracranial pressure. 44 Furthermore, expansion of gas at lower barometric pressure may cause cerebral edema, which could also exacerbate any increase in intracranial pressure. Exposure to long commercial flights possibly leads to mild cerebral hypoxia and edema similar to that in acute mountain sickness and high-altitude cerebral edema. Decompensation as such can further elevate preexisting increased intracranial pressure. 45

There were no published data on the role of prophylactic corticosteroids preflight to prevent development or exacerbation of edema in patients with cerebral tumors, except for the study by Phillips et al 24 noting an inverse correlation between periflight corticosteroid usage and symptom exacerbation. There were also no published data concerning the influence of altitude on the frequency of intracranial hemorrhage.

Inflight acute mountain sickness and life-threatening high-altitude cerebral edema at 11,800 feet altitude have been reported after head and neck surgery or radiation, thought to be the result of a lack of hypoxic ventilatory response from dysfunctioning carotid bodies. Prior hypoxic ventilatory response testing may be useful in this group. 47

In flight, gas in body cavities will expand up to 30%. In intestinal obstruction, a flare in the patient’s symptoms; including nausea, abdominal distention, and pain is expected. 19 For patients with colostomies, intestinal distention may increase fecal output. 4

Air cabin humidity and risk of airborne disease transmission.

Aircrafts also have low cabin humidity, usually ranging from 10% to 20%. 4 This could aggravate thick secretions in patients with tracheostomies, laryngectomies, vocal cord paralysis, or laryngeal dysfunction. Humidified oxygen, adequate hydration, and suctioning can reverse some of these effects. 4

The risk of airborne disease transmission within the confined space of the aircraft cabin is difficult to determine. Commercial airlines are a suitable environment for the spread of pathogens. Transmission of infectious diseases probably happens more frequently than reported for various reasons, including reporting bias and the fact that most diseases have a longer incubation period than air travel. 48 Patients receiving chemotherapy should be aware of peak timing of neutropenia and the risk of infection, and potentially avoid traveling during those periods wherever possible. 31

Medical devices.

Gas expansion also affects medical devices, such as pneumatic splints, feeding tubes, urinary catheters, and cuffed endotracheal or tracheostomy tubes. Gas-expansion concerns in these devices can be eliminated by instillation of water rather than air during air travel. 49 , 50 There were no published data on the effects of reduced atmospheric pressure on the dynamics of pump mechanism, such as continuous subcutaneous infusions of medications through a battery-powered syringe driver, but they should not preclude air travel. 31

Resuscitation orders.

An aircraft in midflight is a unique environment in which to provide medical care. 3 Although advanced health directives or acute resuscitation plans may exist, airline crew members are not mandated by law to follow these directives during inflight emergencies. Therefore, patients and their surrogates should know that cardiopulmonary resuscitation may be initiated. 51

“What Problems Could Happen When I Get There?”

Patients and carers should be aware of potential unforeseen expenses related to illness once they arrive at their destination. These include repatriation, medical escorts, or even air ambulance. In the event of death, arrangements to repatriate the mortal remains back can be challenging and expensive.

The number of patients with cancer who are undertaking air travel is growing every year as a result of lower costs and increasing ease of air travel but also improvements in therapies resulting in better patient performance status and survival. Yet, we found a paucity of evidence to guide the oncology community in assessing the risks of air travel for these patients. There were no specific criteria found and no randomized controlled studies performed.

The case series by Phillips et al 24 was the biggest study performed thus far in patients with brain tumors. The authors found that patients with completely asymptomatic tumors did not develop any symptoms during flight, whereas there was an inverse correlation between periflight corticosteroid use and symptom exacerbation. Their findings support the common clinical practice of prescribing corticosteroids to patients who are symptomatic from mass effect or peritumoral edema, and oncologists would especially do so for those who are planning to travel by air. In fact, many clinicians would not recommend traveling to those patients who were symptomatic.

For patients with lung cancer or lung metastases, or who have been through thoracic procedures, the guidelines suggest referring to a respiratory physician and possibly arranging a hypoxic challenge test. This is not always possible, especially for patients in rural or remote regions. The waiting time for a consultation with a respiratory physician is also sometimes a barrier because many patients do not give their treating team much time for assessment before their planned flying date. In these cases, clinical assessment is of utmost importance. Physical presentations such as preexisting respiratory symptoms, overall functional status, oxygen saturation at sea level, and risks of complications, such as comorbidities exacerbated by hypoxemia, recent surgery or procedures, and recent pneumothorax or pulmonary embolism, need to be taken into account.

Unsurprisingly, no literature was found regarding flying in the setting of malignant pericardial effusion. The condition is relatively rare and often goes undetected if asymptomatic, whereas symptomatic patients are usually less apt to travel.

Traditionally, both health professionals and patients alike had fears that flying would induce or exacerbate postoperative lymphedema. Of all the travel-related complications in patients with malignancy, this issue was the most well studied. Most of the studies were retrospective and observational. The vast majority of studies concluded that there is no evidence to restrict air travel because of risk of lymphedema. These findings are reassuring to patients who are often anxious about flying after breast cancer surgery.

Patients with malignancies are known to have a higher risk of venous thromboembolism while traveling. There is no solid evidence, but the British Thoracic Society recommends considering a preflight prophylaxis dose of low molecular weight heparin in addition to other general recommendations to reduce the risk of VTE while traveling. With new direct oral anticoagulants on the market and emerging studies of usage of direct oral anticoagulants in the cancer population, these recommendations could potentially change to include using these medications for VTE prophylaxis.

In confirmed venous thromboembolism, in the absence of clear evidence, patients should be assessed individually. As long as the respiratory function is adequate and the increased risk of bleeding related to anticoagulation is deemed acceptable, the patient should be able to travel on a commercial flight.

With regard to cardiopulmonary resuscitation, it is unfortunate that there are controversies regarding airline crew members not following advance health directives not to resuscitate during inflight emergencies because of airline regulations. There is a clear need for the development of guidelines to help patients, their carers, and physicians in the setting of air travel. The medical community may need to engage the airline industry to reach clarity about the safety of patients with cancer during air travel. Respecting patients’ wishes should be important at all times, regardless of whether they are in the hospital or midflight.

In conclusion, discussing safety to travel or fitness to fly is a necessary conversation between oncologists and their patients. Minimizing the potential risks can be a complex task, but careful planning and good communication can curtail unexpected obstacles. Valuable information may be sought from travel physicians, airlines, and the embassies or high commissions of destination countries. In the absence of large prospective studies, individual fitness to fly should be assessed on a case-by-case basis bearing in mind that maximizing a patient’s ability to safely travel is an important goal for many individuals with cancer.

ACKNOWLEDGMENT

This project was developed at the Cooperative Trials Group for Neuro-oncology (COGNO) Idea Generation Workshop in 2015.

AUTHOR CONTRIBUTIONS

Conception and design: Sharon Heng, Brett Hughes, Mustafa Khasraw, Zarnie Lwin

Administrative support: Brett Hughes, Zarnie Lwin

Provision of study materials or patients: Brett Hughes, Mustafa Khasraw

Collection and assembly of data: Sharon Heng, Brett Hughes, Mustafa Khasraw, Michael Hibbert, Zarnie Lwin

Data analysis and interpretation: All authors

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jgo/site/misc/authors.html .

Consulting or Advisory Role: MSD Oncology, Bristol-Myers Squibb, Roche, Pfizer, Boehringer Ingelheim, AstraZeneca, Eisai

Research Funding: Amgen (Inst)

Stock and Other Ownership Interests: CSL Limited, ResMed

Honoraria: Pfizer, Novartis

Consulting or Advisory Role: Bristol-Myers Squibb, AbbVie, Eli Lilly

Research Funding: AbbVie (Inst), Bristol-Myers Squibb (Inst), Specialised Therapeutics (Inst)

Travel, Accommodations, Expenses: Genentech

Consulting or Advisory Role: AbbVie, Roche

Research Funding: AbbVie, Bristol-Myers Squibb

Travel, Accommodations, Expenses: AstraZeneca, Bristol-Myers Squibb

No other potential conflicts of interest were reported.

The Masters Apprentices bassist and founding member, Gavin Webb, dies after cancer battle

One of the founding members of legendary Australian rock band The Masters Apprentices, Gavin Webb, has died aged 77 after a six-year battle with cancer.

After being in remission for a few years, the bassist died in the Royal Adelaide Hospital on Tuesday afternoon, the band's label confirmed.

The Masters Apprentices were formed in Adelaide in the mid-1960s when forerunners The Mustangs rebranded.

Webb's involvement had humble beginnings, and came about as a result of a 1965 ad placed by his brother, on his behalf, in Adelaide newspaper The News that simply stated: "Student bass player wishes to practise with group".

The Mustangs' Mick Bower, Brian Vaughton and Rick Morrison spotted the ad and auditioned the bass player, with lead singer Jim Keays joining the group the following year.

Webb, naturally nicknamed 'Spider', went onto perform on the band's self-titled debut album in 1967, with early popular hits including the songs Undecided and Living in a Child's Dream.

"Gavin's band dossier from 1966 says his personal ambition is to 'be a good musician', a humble dream he would go on to transcend," the band said.

"Gavin leaves behind an incredible musical legacy which will live forever in Australia's music history."

After developing stomach ulcers, Webb left the band in 1968, and was succeeded by Glenn Wheatley, who remained as bass player until the band split in 1972.

But Webb rejoined in 1986 for reunion tours, and went onto play with the original line-up when reunited in 2014 following the death of Keays.

The remaining original members today paid tribute to the "softly spoken" Webb who "entered our lives 60 years ago".

"He joined our band as a bassist and from that moment became a member of our family; our brother," the trio said.

"We will greatly miss our Gavin and treasure the life long bond we will share forever — from Mustangs to Masters."

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Gavin Webb, a founding member of The Masters Apprentices, died aged 77 in the Royal Adelaide Hospital on Tuesday afternoon, the band confirmed.

“It is with immense sadness that we announce the passing of our beloved bassist and founding member of ARIA Hall of Fame inducted band The Masters Apprentices, Gavin Webb,” the band said in a Facebook post on Wednesday morning.

They said Webb had been in remission for a few years before the cancer returned.

“Even though Gavin was softly spoken, what few words he did say, he would always make count,” the band said.

“Gavin leaves behind an incredible musical legacy which will live forever in Australia’s music history.”

Webb is survived by his partner Sharon, son Ben and grandchildren Lucy, Noah and Matthew.

His bandmates Mick Bower, Brian Vaughton and Rick Morrison said he entered their lives 60 years ago and became a “brother”.

“We will greatly miss our Gavin and treasure the lifelong bond we will share forever – from Mustangs to Masters,” the band said.

“Our love eternally ‘Spider’.”

The band was formed in Adelaide and was originally named The Mustangs. They later relocated to Melbourne in February 1967 and tried to break into the UK market from 1970.

Their popular singles include “Undecided”, “Living in a Child’s Dream”, “5:10 Man”, “Think About Tomorrow Today”, “Turn Up Your Radio” and “Because I Love You”.

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Prince William returns to public duties for first time since Kate’s cancer shock

Prince William has returned to public duties for the first time since the Princess of Wales revealed she was undergoing chemotherapy.

William attended the food charity Surplus to Supper in Surrey to help out with cooking and loading meals into delivery vans.

He thanked a volunteer for two get well soon cards for his wife and his father King Charles as they both battle cancer.

Well-wishers were also waiting outside to pass on their best wishes.

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Later in the day, he visited a youth centre in London.

The Prince has not been seen at any public engagements since March 19, just days before Kate announced she had been diagnosed with cancer.

The Princess of Wales revealed her diagnosis in a video on March 22, saying it came as a shock.

“In January, I underwent major abdominal surgery in London and at the time, it was thought that my condition was non-cancerous. The surgery was successful,” she said in the video.

“However, tests after the operation found cancer had been present. My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment.”

The Princess said she and William would be spending some time to process it privately for the sake of their young family.

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Remembering Dylan Tombides – the young Australian who left a lasting legacy at West Ham

Every day when George Moncur wakes up, he thanks God for letting Dylan Tombides come into his life. April 18 will mark 10 years since the former West Ham United forward lost a three-year battle with testicular cancer at the age of 20. For Moncur, the date evokes a deeper bond with Tombides.

“The biggest sign is my daughter’s (Saylor Rose) birthday is the same day,” says the now Leyton Orient midfielder. “She will be five on Thursday and her birthday being on the same day Dylan passed away means a lot to me. That just makes me think how real God is, because not only is it the day a special kid was born, but a day my best friend sadly left us.”

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Tombides, who was born in Perth, Western Australia and joined West Ham in 2008, had been diagnosed with testicular cancer in the summer of 2011. Initially, he thought it was a cyst but when he played for Australia at the Under-17 World Cup in Mexico, he was selected for a random doping test and it uncovered a tumour in one of his testicles.

He had been hit by a ball in the groin in a match against Brazil and thought it was nothing more than a routine dull ache. He was told it was testicular cancer while on holiday in the Mexican resort of Cancun with his dad, Jim, and he would need to have a testicle removed.

Tombides fought hard for three years but passed away with his family by his side. There were tributes from West Ham majority shareholder David Sullivan, co-owner David Gold, their long-time academy director Tony Carr, Australia international stalwart Tim Cahill, world football governing body FIFA ’s then president Sepp Blatter and others.

It was a life cut short but many cherish the memories they experienced with Tombides. The forward was regarded as one of the brightest young talents at West Ham and was given his first-team debut by Sam Allardyce in September 2012. He was a team-mate but, more importantly, a close friend of whom Moncur, Matthias Fanimo, Kieran Sadlier and Elliot Lee , a star of Wrexham ’s recent resurgence who wears the No 38 shirt to this day in his honour, will always have a lasting legacy — all have his name tattooed on their wrists.

  View this post on Instagram   A post shared by Elliot (@elliotlee9)

West Ham retired Tombides’ No 38 shirt and paid tribute to him in their first Premier League game after his untimely passing, against Crystal Palace .

“The game was a special moment, knowing what it was representing and the Australian football community,” says Mile Jedinak, Tottenham Hotspur ’s assistant coach and a former Australia international who got the only goal as Palace won that day, but did not celebrate. “I scored a penalty in the game and it was a surreal moment. For Crystal Palace, it meant we were safe in the Premier League but I was mindful of what the game was after I scored.

“I was a young parent then, and all I could think about at the time was wanting to offer my condolences to his family. I could do it after the game, and from that moment, I stayed in touch with them. I was aware Dylan was making waves at West Ham. You don’t play for a club like that if you don’t have something about you. It would’ve been nice to play against Dylan but sadly it wasn’t meant to be. He was well on his way to becoming a big star in the game.”

Last Sunday’s 2-0 loss against Fulham was used to highlight the charity set up in Dylan’s memory, called DT38. Both sets of supporters commemorated Tombides with a minute’s applause in the 38th minute of the match.

Ten years on, The Athletic has spoken to former team-mates, managers and family in tribute to Tombides.

Tombides played his early football in his hometown of Perth and in Hong Kong before joining West Ham as a 14-year-old. He wanted to follow in the footsteps of Australians Cahill and Jedinak by playing in the Premier League. It did not take long for him to impress.

“I remember Dylan turning up to training with a strong Aussie accent, terrible gear and a terrible trim (haircut),” says Dan Potts , who is now at Luton Town in the Premier League. “We came back for pre-season one summer and he looked a completely different player. He was frightening in training. His finishing and touch improved, and then it went on from there.”

For Moncur, his bond with Tombides grew off the pitch, after a slow start.

“When Dylan joined the academy, he was a striker,” says Moncur. “He rocked up to training with this mullet haircut, me and Elliot Lee said, ‘Who is this geezer?’. Then we saw him play, and he was so good. He made his debut under Big Sam (Allardyce) and he was the only one at that time who got near the first team.

“My earliest memory of Dylan is a pre-season trip to Hong Kong. He was in the age group below me for the academy, but because my birthday is in August I got to play with him. We weren’t really close on that trip and we had a little bit of an argument about something, but we just became inseparable after.

#PicOfTheDay – Great mates. Dylan Tombides, the inspiration for our charity, with DT38 Ambassador George Moncur during their #Hammers days 🙌⚽️ #DT38UK #Charity #RaisingAwareness #TesticularCancer #WestHam #Irons #Football #coyi pic.twitter.com/jaKwd9etCs — WeAreDT38 (@Dylantombides) October 14, 2020

“Once, he got the worst haircut in the world; and two days later, I decided to get an even worse haircut. One day, he bought pink football boots, then I decided to do the same. We were brothers. I’m very loud and Dylan was the Australian version of myself. That’s why we got on so well.”

Sadlier, the now Wycombe Wanderers midfielder, often roomed with Tombides on away trips. He would watch his team-mate take his medication daily but, out of respect, never asked Tombides about his mental state.

“You could physically see Dylan was becoming weaker than the others, but I’ve never seen someone so bubbly and happy when they’re going through so much behind closed doors,” says Sadlier. “We’d come back to the changing room after training and our clothes would be taped up — Dylan was a prankster. He was still the same and I used to admire that so much about him.

“I often think seeing us was his release. I never once saw Dylan cry or feel sorry for himself. He was always happy and that’s what sums him up.”

The DT38 Foundation was launched in memory of Tombides in February 2015.

Tracy, his mother, has made it her objective to raise awareness of testicular cancer, the importance of education and self-checking to enable early diagnosis through the charity.

“Dylan was so inspirational,” Tracy says. “Every day, he would get out of bed to fight his disease, even though no one would blame him if he wanted to stay curled up in bed. He pushed himself as much as he was allowed, as West Ham’s medical staff would keep a very close eye on him with regular testing.

“He made it easy to be around him. He made everyone else comfortable about him having cancer. Seeing him get up every day and go in to training gave me such hope that he was winning this fight for his life.

“I don’t know where the time has gone, but the one thing I do know is that he has shaped my existence. I talk to Dylan every day.

“Dylan had an incredible zest for life. He was so determined to be the best version of himself, and the person he inspired the most was me. After Dylan passed away, I was numb. The only thing that was important to me was to give (sibling) Taylor the tools to manage the loss of his brother. We all grieved differently and my focus had to be Taylor and the charity, DT38, that we started in Dylan’s memory.

“This was my reason to get out of bed. I would always say to myself, ‘What would Dylan do?’, and Dylan would be strong and lead by example and make something good out of this heartbreaking situation.

“ I’ve started many things over the past 10 years but the one thing that I’m so immensely proud of is the charity in his memory, and the wonderful legacy that he has left behind. He was such a loveable character and his death will not be in vain.”

Tracy recalls a moment when Dylan, Taylor and Jim were playing their usual round of golf one afternoon and the latter shanked one off the tee. The trio laughed as they wondered where it had ended up. It was only when they returned to the car park that they found what it had hit — their own car’s windscreen.

Tombides once described himself as the “happiest kid with cancer” you could meet.

In January 2012, he had surgery to remove his lymph nodes. Family, friends and staff at West Ham thought Tombides’ condition was improving but the cancer returned. Every time there was a breakthrough, Tombides would receive devastating news of a setback.

Reflecting on his friend’s initial diagnosis still feels surreal for Moncur.

“I’ll never forget the day we found out Dylan was ill,” he says. “It was a Saturday and we had a game at Chadwell Heath (the old West Ham training ground) but Dylan wasn’t there and no one said why. Afterwards, Tony Carr sat us down and said he has testicular cancer. It was out of the blue, and we didn’t see Dylan for ages because he was having his treatment.

“There are so many moments with Dylan that I cherish. We went on a trip and there was this goalkeeper called Jake Larkins. We all got on well but he (Larkins) hated people touching his stuff. We’re at the airport waiting for our flight and he bought the book Fifty Shades Of Grey. I haven’t got a clue why he bought it but he loved the book and read it every day. Me and Dylan managed to get his room key. We’ve both gone in and… made a mess in his book — that’s the PG way of me explaining what happened! Jake eventually found out and went crazy.

“That’s just one crazy story of me and Dylan. We used to throw players’ clothes in the ice bath. Just lots of crazy stuff.”

West Ham are famed as the academy of football, so why are so many youngsters leaving?

Tombides was 18 years and six months old when he made his West Ham debut, off the bench in a League Cup match away to Wigan Athletic on September 25, 2012.

“I gave him his debut on the basis he was fit and well at the time,” says Allardyce. “His hair was growing back, his muscles were redeveloping and he was enjoying his training. We didn’t make a big fuss out of it. He was in the squad on merit.”

Moncur had made his own first-team debut for the club one round earlier in the same competition, against Crewe Alexandra, but there was an acceptance from him and his peers that Tombides would have become a first-team regular.

“Big Sam doesn’t mess about,” says Moncur. “He wouldn’t play kids if he didn’t think they were good enough. People might think Dylan playing was out of sympathy but there’s no chance in that. Myself and others were on the bench loads of times but never came on, so it showed what the manager thought of Dylan.”

Four months after that debut, Tombides was back on high-dose chemotherapy and needed a stem-cell transplant twice within eight weeks. He wanted to represent Australia at the Under-20 World Cup in 2013, but the cancer had spread to his liver.

“It looked like Dylan was heading in the right direction with his recovery and then he kept suffering setbacks,” says Allardyce. “He came back three or four times and you can only imagine the chemotherapy he was going through. From Dylan’s point of view, he probably would’ve found it frustrating, the stop-start nature of his recovery, plus feeling pain.”

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For Moncur, there is always the lingering thought of what could have been: How many appearances would Tombides have made for West Ham in another world? Would he have played for the national team? What type of parent would he have been? Witnessing his friend die so young has given Moncur perspective on life.

“I was in Scotland, on loan at Partick Thistle, and his mum phoned to say Dylan had passed away,” Moncur recalls. “I had to sit down to process what she told me. When I left West Ham, Dylan was getting better and I thought he was on track to fully recovering. I was in shock but for whatever reason he was taken from us. I know Dylan is in a better place and as much as it’s sad and upsetting, my faith in God has helped me cope as the years have passed.

“No matter how tough life gets, you have to enjoy every day. Time goes so fast. You don’t know when your last day is. That’s what Dylan’s death has taught me. He was an unbelievable player but, more importantly, a brother.”

Sadlier was informed of Tombides’ passing by coaches at the training ground. Ten years on and his daily reminder of Tombides adds extra motivation.

😍 SAAAAAAAADDSSSSSS YOU BEAUTY! pic.twitter.com/frZoQVCXUF — Bolton Wanderers (@OfficialBWFC) February 22, 2022

“The hardest part was phoning some of the lads like Elliot and Dan,” he says. “They were the most difficult phone calls I’ve made in my life. That day, me and Dan planned to go to the cinema to watch Spider-Man. I told him what had happened, we decided to still go, so it could help clear our heads, but I couldn’t tell you a single thing that happened in the film.

“A few days after, me, Elliot, and Matthias decided to get tattoos as a tribute to Dylan. When I score a goal, I always kiss mine. He’s always in our thoughts.”

(Top photos: Tombides playing for Australia and a tribute to him in West Ham’s most recent home game/Getty Images)

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