Climate Change: A New Challenge for Radiation Oncology

By Katie Lichter, MD, MPH, Co-chair, Climate Change and Health Equity Task Force

As an intern physician in September 2020, I walked home after a night shift in the intensive care unit with my N95 mask still tightly secured. That morning, we had been advised not to remove our masks despite being outdoors. The air was thick with a reddish-brown haze, an ominous blanket covering San Francisco. It was 8:30 a.m., yet the morning light struggled to penetrate the thick smoke from the Northern California wildfires that drifted downwards over the Bay. Overnight, an elderly man with advanced non-small cell lung cancer had been admitted with disease progression. Due to the wildfires, he had missed several crucial weeks of chemoradiation weeks as he was lost to follow-up, in addition to losing his home and supportive community.

In that moment, I realized that climate change would significantly impact my ability to provide care to patients in the decades ahead. Vulnerable patients and communities were already subject to increasing climate-fueled disasters. Just as COVID-19 had tested the limits of the health care system, I understood that climate change will undoubtedly present new and unexpected challenges for health care professionals and communities alike to navigate.

Over the past few years, radiation oncologists have increasingly faced the fragility of our nation's health care infrastructure due to the pandemic and extreme weather events such as hurricanes, wildfires and flooding. Anna Paulsson, MD, summed it up well when she recently stated, "Practices deal with wildfires and other climate change-fueled disasters events every year, but it is challenging to know how to respond, prepare for clinics and patients, and react to these events." These events can cause radiation oncology facilities to shut down, upending the lives of patients, physicians and care teams crucial to treatment. In 2017, in response to Hurricane Maria, ASTRO collaborated with other health care organizations to direct patients to radiation oncology clinics that could accept displaced patients. However, unmet and growing concerns remain about the impact of climate change on patient care and the need for increased environmentally sustainable practices within radiation oncology.

These concerns are shared by other physician specialty organizations, including the American Medical Association, the American Society for Clinical Oncology and the American College of Radiology. To address these concerns, ASTRO joined the Medical Society Consortium on Climate and Health to advocate for climate change solutions that protect and promote public health. The Consortium also provides educational resources to inform health care professionals about the effects of climate change on patient health and guidance on sustainability best practices.

ASTRO task force to study impact of climate change
In January, the ASTRO Board of Directors approved the establishment of a Climate Change and Health Equity Task Force to explore the impact of climate change on radiation oncology. This task force is charged with developing a policy statement describing ASTRO's commitment to addressing climate change, its impact on radiation oncology and vice versa. The statement will include several key focus areas that will inform future activities. The group has reviewed literature on the impact of climate change on radiation oncology, cancer care and public health, as well as the activities of allied organizations, many of which are still evolving. Emerging from these discussions are areas of interest that include patient and provider education, disaster preparedness, building resiliency, sustainability and decarbonization, and identifying and addressing environmental justice and health equity.

In the coming months, the task force will explore these areas further to determine their impact on radiation oncology. Through these efforts, ASTRO hopes to mitigate the effects of climate change on patient care and promote environmental sustainability practices within our field, and even lead the way in doing so. By prioritizing environmental health and sustainability from a health equity lens, radiation oncologists can ensure equitable delivery of cancer care to all patients and communities, despite a changing climate.

Posted: April 18, 2023 | with 4 comments
Filed under: Board

Shilo Lefresne
As a Canadian radiation oncologist I would like to commend ASTRO on the first steps in implementing this important task force.

During the release of the IPCC AR6 Synthesis Report, the UN Secretary-General Antonio Guterres said “our world needs climate action on all fronts — everything, everywhere, all at once.” This call to action extends to all levels of society: governments, industries, businesses and organizations. All health care providers, including radiation oncologists, have a role to play.

In regards to the article linked in the comment below, it is outside my expertise to critically appraise the manuscript. I do however note that the ‘critical review’ does not describe its methodologies. There is no discussion of search strategy or criteria used for inclusion or exclusion of data. The majority of the references are from 2020 or earlier. This review therefore may not have captured many recent and extreme events such as: British Columbia’s 2021 heat dome, Australia’s Black Summer Bushfire in 2020 which researchers believe actually damaged the ozone layer, India and Pakistan’s heatwave in 2022 in which wet-bulb temperatures exceeded the limit of human survivability for six days, the unprecedented flooding in Pakistan in 2022 which killed 1600 people and displaced 33 million, or the current heatwave in the Mediterranean which scientists believe would happen only once in 40 000 years - just to name a few. I also note, that despite the authors of the referenced article hypothesizing that extreme weather events may not actually be increasing, they still support action on climate change: “This does not mean we should do nothing about climate change: we should work to minimize our impact on the planet and to minimize air and water pollution.”

Implying that climate change has nothing to do with radiation oncology is similar to implying that COVID had nothing to do with our field. COVID strained access to cancer care and screening, exacerbated co-morbidities and impacted patient eligibility and tolerance of therapies, it disrupted supply chains for medical services and forced oncologists to adapt patterns of care. Examples of ways that climate change has already impacted cancer care delivery can be found in the literature. There are even more examples describing the anticipated impacts of climate change on health care services. A good overview can be found at Howard et al (link below). Specific to oncologists, our ability to provide oncologic care at all levels from screening to diagnosis, to treatment and surveillance, to survivorship will be impacted.

Radiation oncologists alone are not going to solve the climate crisis, nor is it our mandate to do so. But, we must do our part both personally and professionally. Thank you Dr Lichter for developing an expertise in this field and your commitment to this very important issue.

5/6/2023 11:29:35 AM

Robert W. Mutter
Thank you for your comments, Mark and GLA. I also do not support the decision of the ASTRO Board of Directors to create a "Climate Change and Health Equity Task Force". Our oncology society is not the place for political advocacy of this nature that is unrelated to the pressing issues facing our field. Regrettably, ASTRO's decision to create this task force on behalf of all its members is one of many divisive examples of late indicating a lack of intellectual diversity within leadership that should concern us all, regardless of our political leanings.
4/21/2023 3:06:03 PM

I really value Mark J Macedon comments. Bravo. He wrote everything in a much more eloquent manner than I could ever do. I agree with everything he said. Nothing that Dr. Lichter has written has anything to do with Radiation Oncology, period. ASTRO has become far too woke.
4/19/2023 8:22:42 PM

Mark J Macedon
You say that you realized climate change would impact your ability to care for your patients going forward because of a wildfire in California. This is a serious failure of reasoning. Wildfires are a part of the ecology of California going back to prehistory. What evidence do you have that they are increasing in frequency and severity and that this is due to climate change? Might changes in forestry practices (especially severe curtailment of the lumber industry beginning in the 1970's) have had a role? What about arson, or ill-maintained power lines?
What evidence do you have that hurricanes are increasing?
And what does any of this have to do with radiation oncology?
For a discussion as to whether extreme weather events are becoming more frequent, start here:
Shorthand version - They are not becoming more frequent.
4/19/2023 3:26:20 PM

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