Climate change poses a distinct threat to population health through a variety of mechanisms, including increasingly frequent natural disasters, heightened exposure to harmful ultraviolet (UV) rays and pollutants, and environmental conditions that allow both infectious and chronic diseases to flourish.

In recent years, studies have examined the effects of climate change on cancer specifically, and the implications for patients and health systems are drastic. Below, we examine the connection between climate change and cancer and pose questions provider organizations can use to gauge their preparedness.

Climate change worsens cancer risk and cancer survival

Climate change increases the risk of most cancers by heightening exposure to carcinogens.¹ Specific types of cancer — such as lung and skin cancers – are especially at risk of increasing due to climate change. The greatest threats are from air pollution, industrial toxins, and UV radiation.²

• Air pollution: Air pollution is the byproduct of human activities. It is also a consequence of wildfires, which are becoming more intense and more frequent in the face of climate change. The maximum level of PM2.5 — a carcinogenic pollutant produced by wildfires — recommended by the World Health Organization is 5 micrograms/m³, above which the risk of harm to human health significantly increases.³ The Northern California wildfires in 2020 produced a record high PM2.5 level of 453 micrograms/m³, carried by smoke plumes that stretched across North America and degraded air quality for months.
• Industrial toxins: Increased flooding near industrial sites can release carcinogenic toxins into surrounding communities, compounding the risk of cancer caused by regulated release of industrial pollutants.³ Hurricane Harvey, for example, swamped chemical plants, oil refineries, and Superfund sites containing half a billion gallons of industrial wastewater in the Houston area. As a result, carcinogens like benzene, vinyl chloride, and butadiene were released into nearby neighborhoods and waterways, greatly increasing the risk of cancer for locals. Researchers measuring exposure to cancer-causing substances like flame retardant and pesticides found that the levels Houston residents were exposed to exceed the recommended lifetime limits.^4,5,6
• UV radiation: Exposure to cancer-causing UV radiation is largely caused by ozone layer depletion, which is facilitated by human use of artificial chemicals known as ozone-depleting substances. As the protective layer of the atmosphere thins, more harmful radiation reaches the earth. From 1994 to 2014, the number of skin cancer diagnoses in the U.S. increased by 77%, and the rise was directly correlated with exposure to UV radiation.⁷

Climate change also worsens outcomes among existing cancer patients. Extreme weather events impede patients' access to care and providers' ability to deliver care, primarily due to obstruction or damage to infrastructure, communication systems, and medication supplies, as well as medical record losses.^1,8

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Extreme weather events adversely affect all types of patients, but cancer patients are especially vulnerable to delays in diagnosis, delays in treatment initiation, and treatment disruption.³ A 2019 study found that patients with non-small cell lung cancer were significantly more likely to die if their radiation therapy was interrupted by a hurricane.

Why does this matter?

Cancer patients are complex, requiring a high level of care coordination and expensive treatments, and cancer care in the U.S. is becoming more costly — both for patients and for health systems.^9,10 In 2011, NIH predicted that U.S. expenditures for cancer would be at least $158 billion by 2020, but in actuality, the estimated expenditures for cancer in 2020 were nearly $210 billion.^11,12

As the cost of cancer care rises, patients and provider organizations will struggle to cope with the effects of climate change. Patients will suffer from the effects of under-prepared facilities and high treatment costs, and provider organizations will be forced to grapple with a population whose expensive needs cannot be met. Provider organizations need to ramp up their preparedness for the future influx of high-acuity patients.

Questions for providers to consider

Healthcare leaders might know they should take steps to prepare for climate change, but climate action often falls to the backburner in favor of issues perceived to be more urgent — or more manageable. This cannot continue forever. Help your organization prepare for the inevitable impacts of climate change on cancer care by answering these questions:

What climate-related disasters pose threats to your community and organization — for example wildfires, severe storms, floods, heat waves? 

By considering the geographical threats relevant to your area, you can tailor your organization's adaptation and incident response strategies and better prepare for disruptions. Consider staffing needs, facility resources, bed capacity, and partner organizations.

Is your organization certified for extreme weather preparedness?

After Hurricane Sandy, the New York mayor developed a plan for hospitals to become certified in extreme weather preparedness to improve flood resistance, expand access to backup power, and create plans to avoid emergency evacuations. Similar options exist in other regions. Becoming certified would not only help your organization respond more efficiently; it would also make it a preferred site of care for disaster response.

Are your home health or mobile nursing units equipped to deliver chemotherapy to patients who are unable to reach hospitals or treatment centers?

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Damage to roads and infrastructure and disruptions to public transportation prevent many patients from accessing health services. Preparing home-based health services in case of emergencies can help minimize the adverse effects of disruptions to care.

How can telehealth services be expanded to offer preventive screenings and to accommodate cancer patients in need of routine care?

Although telehealth comes with its own challenges, enhancing virtual cancer services can help bridge the gap for patients who are unable to access facilities in-person. 

Soon, climate change will be impossible for the healthcare industry to ignore, so planners must consider how to help their organizations avoid undue disruption by thinking about preparedness strategies now.

Footnotes

1. Nogueira LM, et al., “Association Between Declared Hurricane Disasters and Survival of Patients With Lung Cancer Undergoing Radiation Treatment,” Journal of the American Medical Association, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6635902/
2. “Climate Change Will Give Rise to More Cancers,” University of California San Fransisco (UCSF) News, November 2020, https://www.ucsf.edu/news/2020/11/418976/climate-change-will-give-rise-more-cancers
3. “Climate Change and Cancer,” Harvard T.H. Chan School of Public Health, May 2020, https://www.hsph.harvard.edu/c-change/news/climate-change-and-cancer/
4. “Following Hurricane Harvey, Pollutant Levels in Houston Neighborhood Exceeded Limit for Increased Cancer Risks,” Texas A&M University School of Public Health, March 2021, https://today.tamu.edu/2021/03/26/following-hurricane-harvey-pollutant-levels-in-houston-neighborhood-exceeded-limit-for-increased-cancer-risks/
5. “Chemical Exposure for Houston Residents Increased Directly after Hurricane Harvey, Study Shows,” Houston Public Media, July 2022, https://www.houstonpublicmedia.org/articles/news/health-science/2022/07/29/429358/chemical-exposure-for-houston-residents-increased-directly-after-hurricane-harvey-study-shows/
6. “Hurricane Harvey's Toxic Impact Deeper than Public Told,” AP News, March 2018, https://apnews.com/article/environment-hurricanes-storms-tx-state-wire-north-america-e0ceae76d5894734b0041210a902218d
7. “Why Is Skin Cancer Rising?” U.S. News, June 2019, https://health.usnews.com/health-care/for-better/articles/why-is-skin-cancer-rising
8. Man RX, et al., “The Effect of Natural Disasters on Cancer Care: A Systematic Review,” Lancet Oncology, https://pubmed.ncbi.nlm.nih.gov/30191852/
9. “What's Behind High U.S. Health Care Costs,” The Harvard Gazette, March 2018, https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more-for-health-care-with-worse-population-health-outcomes/
10. “The Rising Cost of Cancer Care,” American Association for Cancer Research, n.d., https://www.aacr.org/patients-caregivers/progress-against-cancer/the-rising-cost-of-cancer-care/
11. Park J & Look KA, “Health Care Expenditure Burden of Cancer Care in the United States,” Inquiry, https://pubmed.ncbi.nlm.nih.gov/31583928/
12. “Financial Burden of Cancer Care,” National Cancer Institute, April 2022, https://progressreport.cancer.gov/after/economic_burden