The climate summary at the end of 2024 revealed that the Earth continues to experience significant and record-breaking heat. Like a pop album that remains steadfastly perched atop the top 10 list, frightening climate news will not go away. Yet, we cannot turn to a different channel.
While particular aspects of the climate emergency garner the majority of the media attention — such as rising sea levels, increased frequency and intensity of heat waves and wildfires, and rapid intensification of hurricanes — the warmer environment also poses significant risks for cancer patients and their caregivers. This article will briefly summarize the pertinent issues and the strategies that healthcare providers and hospital systems will need to use to optimally provide care as the climate continues to change, as well as actions to take to decrease healthcare’s large carbon footprint.
Environment-Linked Cancer
The relationship between fossil fuel production, air pollution, and diseases, especially lung cancer, has been known for a while, but data continue to accumulate on the myriad health issues related to the inhalation of PM 2.5 in particular. Both air pollution and climate change are driven by carbon released into the atmosphere by human activity. Many of the resulting diseases are not malignant: think asthma in children; dementia; increased incidence of coronary disease; low birth-weight babies; and so on.
But data have now shown that exposure to pollution, whether from industrial sources or burning fires, increases the risk of lung cancer in both smokers and non-smokers. And pollution does not only trigger cancer development; recent data suggest that patients who undergo surgical resection of an early stage lung cancer and who live in zip codes with high PM 2.5 concentration have inferior survival. Air pollution has also been associated with increasing the risk of women developing breast cancer. Thus, continued efforts to move towards renewable energy and decrease carbon emissions will help countries meet climate goals and improve population health.
Beyond pollution, other environmental changes are linked to cancer too. When storms move ashore with great intensity, they can flood Superfund sites (sites that have already been designated as containing toxic chemicals) and release carcinogens into rivers and highly populated areas. This has been linked to cancer development. Many Superfund sites are unfortunately situated along the Gulf and East Coast, and thus they may remain in harm’s way.
Interruption of Cancer Care
Beyond a direct link to illness, the climate crisis can also adversely affect the delivery of care to cancer patients. Hurricanes that now intensify rapidly and drop more water (and hence cause more flooding) can cause significant urban damage. The hurricanes that devastated North Carolina last summer offer a clear example. Emergency services are threatened, facilities are ruined, patients may need to be transferred, communication is difficult, and valuable records and research samples can be lost. Radiation and infusion centers, even if not directly damaged, can remain closed for weeks, thereby interrupting care, which can lead to worse outcomes. Floods and fires can also prevent facility staff from getting to the hospital to provide care.
Meanwhile, data show that cancer screening rates drop during and after significant weather events. Storms also threaten supply chains. For example, the North Carolina storms destroyed a facility where IV fluid bags were manufactured, forcing hospitals and clinics across the nation to have to improvise.
Hurricanes are not the only weather events that can put cancer care delivery at risk; wildfires can also cause population displacement and significant interruption of care. The wildfire season is getting longer, and the fires themselves are getting more frequent and intense — as illustrated by the Los Angeles wildfires this year.
Toward a Greener Healthcare System
The U.S. healthcare system generates 8.5% of the country’s total carbon emissions, a fact that continues to surprise many physicians. The sources are multiple: massive hospitals and medical centers use a tremendous amount of power; operating rooms generate a great deal of single-use waste; and rural or remote staff and patients often have to travel long distances. Healthcare workers need to work with administrators to develop strategies to use hospital power more intelligently (“green” healthcare delivery). In addition, biomedical waste must be reduced.
Life cycle analyses are tools to evaluate and assign the amount of carbon associated with particular medical interventions. These analyses need to be more widely utilized to help clinicians choose interventions for their patients that have the lowest possible carbon footprint, while not sacrificing outcomes. Shorter course radiotherapy or more widely spaced infusions of IV medications could potentially decrease travel to clinics and hospitals. Telehealth could also be more widely used, when appropriate, to manage patient care for those who live far away from a health facility.
Climate change and the associated extreme weather events will continue to adversely affect the delivery of healthcare. Cancer patients — because of the complexity of their multidisciplinary care — are vulnerable to the interruptions in care posed by environmental crises. Healthcare providers should get involved with their hospitals and healthcare systems in matters of resiliency and greening; they need to continue to advocate and educate through their professional societies; and they need to be prepared to care for their sick patients in a rapidly changing world.
Eric Bernicker, MD, is enterprise medical director of Medical Oncology at CommonSpirit Health, Mountain Region. He is also vice chair of Oncology Advocates United for Climate and Health – International. Joan H. Schiller, MD, is chair of Oncology Advocates United for Climate and Health – International. She is also a board member of the Lung Cancer Research Foundation, and former deputy director of UT Southwestern Simmons Cancer Center.
The views of the author do not necessarily reflect those of the Medical Society Consortium on Climate and Health or its members.
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