Record-breaking temperatures and recent devastating wildfires continue to underscore why climate change is one of the most pressing public health challenges of this century. When extreme weather events impact unprepared communities, disasters can happen.
In a key step toward better understanding the impact of climate-related disasters on cancer care and identifying best practices in disaster preparedness and response, the ACS Commission on Cancer (CoC) and the American Cancer Society plan to launch a disaster risk management collaborative in the coming months.
Notably, the cancer care continuum—from prevention, screening, and diagnosis through treatment and survivorship—involves multiple interactions with the healthcare system, all of which can be disrupted by climate-driven disasters.1,2 As a result, patients with cancer are especially vulnerable to disruptions in access to care.
Specifically, as climate change increases the frequency and severity of extreme weather events, it becomes harder to prepare for and respond to unpredictable circumstances, further exacerbating the vulnerability of this patient population.
Previous research using the National Cancer Database—a hospital-based cancer registry jointly sponsored by the College and the American Cancer Society that includes 74% of cancer cases in the US—described how hurricane disasters disrupted access to radiation treatments and were associated with an increased risk of death for patients with non-small cell lung cancer, compared to similar patients treated at the same facility in the absence of a disaster.3
In this study, 1,734 patients exposed to a hurricane disaster had longer radiation treatment duration (66.9 versus 46.2 days, p<0.01) and a 19% higher risk of death (hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.07-1.32), compared to 1,734 propensity score-matched unexposed patients.3 Additionally, longer declarations were associated with worse survival.3
The impact of extreme weather events also may be experienced far outside of the immediately affected local region. For example, there were notable disruptions to medical infrastructure and the supply chain in 2024 when Hurricane Helene flooded an intravenous (IV) bag factory in Marion, North Carolina, which produces approximately 60% of the IV fluids used in the US. When the plant was damaged and forced to close, it caused a nationwide shortage of IV fluids.
Similarly, in 2018, Hurricane Maria in Puerto Rico wiped out the electrical grid and devastated another key supplier of IV bags, causing widespread and critical shortages of this product for hospital systems across the US, including many cancer treatment facilities.4
Hurricanes are not the only climate-driven disasters that can result in disruptions to cancer care and poor outcomes. Proximity to wildfires increases the risk of exposure to air pollution and water and soil contaminated with the byproducts of burned materials, not to mention the challenges associated with the psychosocial and economic demands of rapidly changing evacuation orders.
A study published in 2023 showed that exposure to a wildfire up to 6 months after discharge following lung cancer surgery was associated with higher mortality risk, compared to unexposed patients.5
The research showed that 168,645 patients exposed to a wildfire up to 12 months after discharge following lung cancer surgery had worse overall survival compared to unexposed patients, with the greatest hazard seen for patients exposed between 0 to 3 months after discharge (HR 1.43; 95% CI 1.41–1.45).5
Climate change-driven increases in wildfire activity underscore the importance of leveraging existing research infrastructure for identifying populations at high risk from these events and for improving the ability of healthcare systems to prepare for and respond to threats posed by climate change.
With 2024 confirmed to be the warmest year on record,6 healthcare providers and other stakeholders must continue to proactively address the serious consequences that heat waves and other extreme weather events can have for patients diagnosed with cancer.
The risks faced by this vulnerable population are compounded especially in those with advancing age or those with limited access to resources.7 Adaptation strategies are needed to prepare health systems, communities, and patients for coping with the consequences that extreme weather events have on cancer care delivery and outcomes.
These strategies should focus on healthcare infrastructure improvements such as facility upgrades, medical supply stockpiles, and data backup systems. In addition, early warning systems, community preparedness plans, patient support mechanisms, and flexible treatment schedules could help ensure continuity of care during disruptions related to extreme weather.
Health systems should implement targeted interventions to recognize and respond to the specific needs of their communities while ensuring equitable distribution of support and resources. Discriminatory policies and practices also can result in some patients receiving diminished or limited cancer care as they experience climate-related events.
Individuals from communities that are typically impacted first and worst by these conditions have developed innovative climate adaptation solutions that are relevant to the entire healthcare system. For example, the Centers for Medicare & Medicaid Services (CMS) now authorizes healthcare facilities to use microgrids as emergency power sources based on the experiences of the residents of Puerto Rico.
After Hurricane Maria devastated the electrical grid in Puerto Rico, residents experienced the limitations of relying on diesel-powered generators, which can be an unreliable source of power in these circumstances and can worsen health outcomes due to exposure to diesel exhaust.8
As evidenced by this real-world example, it is imperative that healthcare leaders move beyond simply recognizing how climate-driven events may exacerbate existing cancer disparities and develop strategies to mitigate the impact of climate change by learning from the experiences of others.1
The capacity of healthcare systems to prepare for and respond to threats posed by climate change must be continuously re-evaluated to keep pace with the increasing unpredictability and severity of extreme weather events. CMS currently requires all participating facilities to have emergency preparedness plans in place.9 However, there are no coordinated research efforts focused on sharing lessons learned or developing best practices for preparing for and responding to climate-driven threats to cancer care delivery.8
The new collaborative effort from the ACS CoC and American Cancer Society aims to make it easier to exchange ideas and information by creating a platform for developing, implementing, and disseminating emergency preparedness and response strategies. While some hazards are event-specific, many disaster risk management functions, including dealing with power outages, establishing patient transfer agreements, and managing challenges with accessing electronic health records, are similar.
This project will include a repository of current disaster risk-management practices and leverage diverse expertise from approximately 1,400 programs that have been invited to participate in other voluntary CoC National Quality Improvement collaboratives. The goal of these 12-month collaboratives is to improve the quality of care for cancer patients. Notably, the first collaborative was launched in 2021 to measure and reduce local cancer screening deficits after the COVID-19 pandemic.10
Results from this particular collaborative will be critically important to the development of a best practices toolkit that cancer programs can use to improve facility resilience, maintain high-quality cancer care, and reduce the risk to cancer patients whose communities experience disasters related to climate change.
Dr. Kelley Chan is an ACS Clinical Scholar with ACS Cancer Programs in Chicago, IL.
References
- Nogueira LM, Yabroff KR. Climate change and cancer: The environmental justice perspective. J Natl Cancer Inst. 2024;116(1):15-25.
- Nogueira LM, Yabroff KR, Bernstein A. Climate change and cancer. CA Cancer J Clin. 2020;70(4):239-244.
- Nogueira LM, Sahar L, Efstathiou JA, Jemal A, et al. Association between declared hurricane disasters and survival of patients with lung cancer undergoing radiation treatment. JAMA. 2019;322(3):269-271.
- US Food and Drug Administration. FDA commissioner Scott Gottlieb, MD, updates on some ongoing shortages related to IV fluids. US Food and Drug Administration. FDA news release; 2018. Available at: fda.gov/news-events/pressannouncements/fda-commissioner-scott-gottlieb-md-updatessome-
ongoing-shortages-related-iv-fluids. Accessed January 7, 2025.
- Zhang D, Xi Y, Boffa DJ, Liu Y, et al. Association of wildfire exposure while recovering from lung cancer surgery with overall survival. JAMA Oncol. 2023; 9(9):1214-1220.
- National Aeronautics Space Administration. Temperatures rising: NASA confirms 2024 warmest year on record. Available at: https://www.nasa.gov/news-release/temperatures-risingnasa-confirms-2024-warmest-year-on-record/. Accessed January 7, 2025.
- Hassan AM, Nogueira L, Lin YL, Rogers JE, et al. Impact of heatwaves on cancer care delivery: Potential mechanisms, health equity concerns, and adaptation strategies. J Clin Oncol. 2023; 41(17):3104-3109.
- Espinel Z, Shultz JM, Aubry VP, et al. Protecting vulnerable patient populations from climate hazards: The role of the nation’s cancer centers. J Natl Cancer Inst. 2023;115(11):1252-1261.
- Centers for Medicare & Medicaid Services. Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers: Final rule. 2016; 63859. Available at: https://www.cms.gov/Medicare/Provider-
Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule. Accessed January 7, 2025.
- Joung RH, Nelson H, Mullett TW, et al. A national quality improvement study identifying and addressing cancer screening deficits due to the COVID-19 pandemic. Cancer. 2022; 128(11):2119-2125.
