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Make the Correct Certification Determination
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What Would You Do?

This recurring newsletter is designed to keep your mind sharp and well-informed about DOT regulations and guidelines related to physical exams, drug testing, and breath alcohol testing. Each edition features an exam scenario, accompanied by a concise discussion on navigating the exam in accordance with regulations, guidelines, recommendations, and clinical best practices. 


Stay informed, stay compliant! 

Scenario: 

A 56-year-old male presents for a DOT physical. They have been undergoing radiation therapy for stage 2 prostate cancer for the last 3 weeks. This has caused him to have diarrhea, but he denies any other side effects. There is no other significant medical history, and all findings of the exam are within normal limits. 

What would you do?

Discussion:

According to the National Cancer Institute, breast cancer is the most common cancer diagnosis. Prostate cancer is the leading cancer diagnosis among men and the second most common diagnosis overall. Lung cancer is the third most common cancer diagnosis. 


The numerical staging system classifies cancers into four stages, with stage 1 as the earliest stage. At both stages 1 and 2, the cancer has not spread to anywhere else in the body. If cancer is diagnosed during stage 3, it’s likely that it has spread, at which point the chances of survival decrease as disease prognosis worsens.


An early stage of cancer might respond best to surgery and radiation, while a stage 4 cancer might respond better to chemotherapy or targeted therapy.


Survival Rates
Survival rates can vary by cancer type, stage, and a person's overall health. The highest survival rates are seen in individuals with thyroid cancer, testicular cancer, melanoma of skin, and prostate cancer. The cancers with the lowest survival rates are pancreatic cancer, brain cancer, liver cancer, and lung cancer.

  • Breast cancer: 99–100% for stage 1, decreasing to 86% for stage 3, & 30% for stage 4

  • Prostate cancer: 99% for stages 1-3, 50% for stage 4

  • Testicular cancer: 99% for localized tumors & 96% for tumors that have spread to the lymph nodes

  • Melanoma of skin: 99% for stage 1, 74% for stage 3, 30% for stage 4

  • Thyroid cancer: 98–100% for stage 1 & 2, 93% for stage 3, 51% for stage 4

  • Cervical cancer: 91% for stages 1 & 2, 40% for stage 3, 17% for stage 4

  • Leukemia: 66.7% for all stages

  • Lung cancer: 65% for stage 1, 40% for stage 2, 15% for stage 3, 5% for stage 4

  • Pancreatic cancer: 44% for stages 1 & 2, 16% for stage 3, 3% for stage 4

  • Brain cancer: 35% for stages 1 & 2, 30% for stage 4

  • Liver cancer: 50-70% for stage 1, 20-50% for stage 2, 10-20% for stage 3, 4% for stage 4 


Treatment Side Effects

Side effects can vary from person to person and from treatment to treatment, to the extent that two people receiving the same treatment may experience very different side effects. Some experience side effects that arise during treatment and improve over time, but some people experience severe side effects that last for months or even years after treatment is completed.

  • Nausea and vomiting: Immunotherapy, radiation therapy to the abdomen, and chemotherapy are all known to cause nausea and vomiting.

  • Fatigue: Cancer-related fatigue is a severe form of fatigue often described as an overwhelming tiredness, exhaustion, and weakness that doesn’t go away with sleep and rest. Fatigue is especially common as a result of chemotherapy. Pain: A common side effect that can include leg cramps, peripheral neuropathy, and pain. 

  • Anemia: Treatments that can cause anemia include chemotherapy, radiation therapy and some immunotherapies. 

  • Hair, skin, and nail problems: Radiation therapy can bring hair loss to the part of the body receiving radiation, while chemotherapy can lead to loss of hair on the head and other parts of the body. Skin-related side effects can include dryness, itchiness, redness, and swelling. Individuals may also experience changes in their nails, like darkening, yellowing, or cracking of the nails and/or cuticles.

  • Mouth problems: Anticancer drugs and radiation to the head and neck can damage salivary glands and tissues in the mouth, throat, and lips. This can cause difficulty swallowing, changes in taste, dry mouth, infections in the mouth, mouth sores, tooth decay, and sensitivity to hot and cold food. 

  • Changes in thinking and memory: Chemotherapy can make it difficult to remember or process information. 

Conclusion:

There are many variables to take into consideration when making a certification determination for a driver with cancer. It’s important to know the type of cancer, its stage, the prognosis, if the treatment is effective, and if the condition is stable.


Side effects can vary from person to person and from treatment to treatment. The ME should consider the side effects that the individual or their treating provider are reporting and determine whether these side effects interfere with the individual’s ability to meet the demands and duties of a driver.


The individual in this scenario with stage 2 prostate cancer has a 99% survival rate. Their only reported side effect is diarrhea which is not likely to interfere with their ability to operate a CMV. The ME should consider obtaining a clearance letter from the treating provider to verify the information being provided. If everything checks out, the ME may consider certifying this individual. There is no designated waiting period and while there is no designated certification interval, the general consensus is to limit certification to one year or less. 


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