treatments that would improve out- comes for patients with cancer, which could potentially have an impact on thousands of lives for years into the future.
Climate change can also block access
to health care from increasing temperatures, too much or too little rain, and severe weather events. Increases in the frequency and severity of extreme weather events (heavy downpours, floods, droughts, and major storms) can cause injury, death, and displacement; can knock out power and phone lines; damage or destroy homes, roads and bridges; and affect chemical plants, oil refineries, and superfund sites, all of which increase the risk of exposure to carcinogens.16 From a health perspective, these events can impede access to medical care, reduce the availability of safe food and water, and separate people from their medicines. In 2005, Hurricane Katrina, a category 5 hurricane, caused a significant number of deaths, with more than 700 bodies recovered in New Orleans. An estimated 215 nursing home residents and hospitalized patients died, including those in Memorial Medical Center where 45 corpses were recovered. At Charity Hospital, 200 patients were not evacuated until 5 days after the hurricane, and they had been without power or fresh water during that time period. Hurricane Dorian slammed into the Bahamas with sustained winds of 185 mph, producing deluges of rain and a storm surge that was two stories high onshore, which submerged entire neighborhoods and resulted in health consequences from widespread power outages, water contamination, inoperative sanitation systems, and acute food insecurity.21
Climate change has had negative impacts on treatment and outcomes for patients with cancer.21 For example, a retrospective analysis of 1,734 patients undergoing definitive radiotherapy for non-operable locally advanced non–small-cell lung cancer during hurricane disasters and 1,734 propensity matched patients who underwent radiotherapy without being exposed to a natural disaster found that undergoing radiotherapy during a natural disaster was associated with worse overall survival; the adjusted HR was 1.19 (95% CI, 1.07 to 1.32; P = .001).22 Patients affected by a hurricane disaster had longer durations of radiation treatment (66.9 v 46.2 days; P < .001) The adjusted relative risk for death increased with the length of the disaster declaration, reaching 1.27 (95% CI, 1.12-1.44) for disasters lasting 27 days. In 2001, for example, Tropical Storm Allison, bringing with it 38.6 inches of rain, caused major damage in the Texas Medical Center, which includes Baylor College of Medicine, MD Anderson Cancer Center, and The University of Texas Health Science Center at Houston. Hundreds of thousands of research animals and tumor samples were lost, as was 25 years of research data, including, for many scientists, their life’s work.
Climate change resiliency will require major adaptations. Although overall patient visit volumes have decreased dramatically since the beginning of the COVID-19 pandemic in the United States, telehealth visits overall have increased 300-fold.20 Visits for pain, depression, and anxiety—all conditions that our patients commonly have—decreased by 37%, 40%, and 31%, respectively.20 In a recent article by Liu et al23 in this journal, one health care system is leveraging telehealth
experience for oncology patients during environmental disasters (wildfires) and the COVID-19 pandemic. However, telehealth will be compromised during power outages from storms, so additional creative solutions will be required to ensure continuity of cancer care.
Because severe weather events will make it more difficult to engage in face-to-face encounters, medical events will be postponed, cancelled, or presented in virtual formats. Although large-scale virtual meetings with real-time presentations and enduring presentations, slides, and videos are possible (The Community Oncology Alliance, ASCO, and the American Association for Cancer Research all reported increased numbers of attendees in 2020), the full impacts are not yet known. An editorial in The Lancet Oncology15 stated, “As a result, innumerable opportunities for discussion and collaboration will be lost, the latest research will not be presented, and patients will subsequently be affected by the delay in dissemination of information on the latest treatment to their doctors.”15(p467)
So, yes, we owe it to our families, ourselves, and especially to our patients with cancer, to be concerned about climate change. As respected, trusted messengers, physicians play a unique role in addressing climate change.15 We can advocate for our patients by supporting health care systems in developing ways to reduce the health risks of climate change.24 We can promote healthy behaviors and policies with low environmental impact, support policies to reduce the environmental footprint of society in general and the health care system in particular, advocate for appropriate preparedness for expected increased emergence of new pathogens, and undertake research and education on climate change and health.25 If we promote “actions to combat climate change and lessen our use of fossil fuels [we] could prevent cancers and improve cancer outcomes, [and] we might see . . . the attainment of our mission to reduce suffering from cancer grow nearer.”16(p242)
© 2020 by American Society of Clinical Oncology
AUTHOR CONTRIBUTIONS
Conception and design: All authors
Collection and assembly of data: Joan H. Schiller, Steven D. Averbuch
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
Why Oncologists Should Care About Climate Change
The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. 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/op/authors/author-center.
Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).
Joan H. Schiller
Consulting or Advisory Role: Genentech, AstraZeneca, Merck
Speakers' Bureau: AstraZeneca
Travel, Accommodations, Expenses: Genentech
Other Relationship: Free to Breathe, Lung Cancer Research Foundation
Steven D. Averbuch
Employment: Bristol Myers Squibb (ret)
Stock and Other Ownership Interests: Bristol Myers Squibb, Merck, Illumina, Guardant Health, Bluebird Bio, Natera, Gilead Sciences, QIAGEN, Regeneron, Exact Sciences, Editas Medicine, Moderna Therapeutics, Abbott Laboratories, Johnson & Johnson, Medtronic, Pfizer, Becton Dickinson
Consulting or Advisory Role: Caris Life Sciences, GMDx Genomics, Immunai, NeoTx, Notable Labs, NovellusDx, OrbiMed, PathAI, PMV Pharmaceuticals Pincus
Travel, Accomodations, Expenses: Caris Lifesciences
Christine D. Berg
Consulting or Advisory Role: GRAIL, Mercy BioAnalytics
Travel, Accommodations, Expenses: GRAIL
No other potential conflicts of interest were reported.
REFERENCES
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5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
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