Calling for cancer centers to lead on climate disaster preparedness

Cancer centers are uniquely positioned to protect communities and their most vulnerable residents—cancer patients—from climate-driven disasters by bolstering emergency preparedness, noted researchers with Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, the American Cancer Society (ACS) and collaborating organizations.

Writing in a commentary in the Journal of the National Cancer Institute, the researchers noted that all 71 of the country's NCI-designated cancer centers have been impacted by one or more climate-related disasters during the past decade.

Wildfires. Floods. Hurricanes and tropical storms. Severe ice and snowstorms. Extreme heat events. Cancer centers have gained experience dealing with all types of climate hazards, according to the researchers.

Additionally, the centers already have emergency preparedness plans in place as required by the Centers for Medicare and Medicaid Services (CMS), the agency overseeing these federal health programs.

"During the COVID-19 pandemic, it became clear that cancer centers can adapt quickly to challenging circumstances and develop best practices to prioritize patient and public safety," said Leticia Nogueira, Ph.D., ACS's scientific director for Health Services Research and the paper's corresponding author, "the same type of prioritization and collaboration between institutions and professionals from different backgrounds is urgently needed to better prepare and response to climate-driven disasters."

Gaps in emergency preparedness

However, while cancer centers adapted quickly to the challenges posed by the pandemic, the researchers identified some significant shortcomings in emergency preparedness among the cancer centers when it came to climate-related disasters, especially when it came to protecting the health and safety of cancer patients.

For the analysis, the researchers conducted an extensive audit of the centers' websites to identify and categorize current preparedness information, guidance and practices. Their review revealed some glaring information gaps and deficiencies, including:

• Only half of the centers posted preparedness information specifically for cancer patients.
• Less than 25% contained emergency information for climate disasters, despite their increasing frequency and severity.
• Less than 10% of centers provided cancer-specific emergency preparedness material related to climate-driven disasters.
• Only one center's website included information on maintaining psychological health and well-being during climate disasters.

Although some websites outlined steps that individuals can take to boost personal preparedness, including making disaster kits and evacuation plans and ensuring pet safety, very few—about 5%—included cancer-specific recommendations such as: pre-registering for special-needs shelters, requesting additional medical supplies before disasters, creating portable medical cards containing vital personal health information and stocking medical items in disaster kits.

"As a psychiatrist, I know firsthand that the diagnosis and treatment of cancer brings about a multitude of stressors related to the physical, psychological and socioeconomic consequences of the disease," explained Zelde Espinel, M.D., Sylvester clinician and researcher and lead author of the paper. "Patients living with cancer—and their caregivers and care providers—have distinctive needs and vulnerabilities that are further amplified when faced with the risks posed by climate-driven extreme weather events."

Roadmap for cancer-specific future preparedness

"Despite current shortcomings, NCI-designated cancer centers are well-positioned to advance knowledge and expertise about "climate-proofing" health care operations for cancer patients and others," said Tracy Crane, Ph.D., RDN, co-lead of Cancer Control and director of Lifestyle Medicine, Prevention and Digital Health at Sylvester, and one of the paper's authors. "They have greater access to resources through accreditation, established relationships with other health care organizations and are trusted entities within their communities."

Additionally, the centers already have CMS-compliant emergency-preparedness plans that should be evaluated and revised, as needed, to better protect medically vulnerable populations during climate disasters.

Moreover, the centers can build on existing resources for centralized information sharing, such as the NCI's "Emergency Resources for the Cancer Community," ACS's "Guide to Getting Ready for a Natural Disaster" and the Department of Health and Human Services' website with hazard-specific content for actions before, during and after disasters. Other federal and local resources are readily available and should be utilized as appropriate.

The researchers also recommended structured information sharing among cancer centers to share lessons learned from previous climate disasters and coordinated research efforts that promote collaboration in evidence-gathering, data analysis, implementation strategies and communication methods that can result in best practices.

"Our research takes on even greater significance during the expansive heatwaves and climate disasters of 2023 as we encourage national cancer centers to pursue innovative strategies for enhancing emergency preparedness for their patients, providers, other staff and care systems in this current era of compounding disasters," said co-author James M. Shultz, Ph.D., Sylvester researcher and associate professor of public health at UM Miller School of Medicine.

His Protect and Promote Population Health in Complex Crises research program focuses on safeguarding medically high-risk patients, particularly cancer patients, from disaster threats.

"Climate-related disasters are only expected to increase in the coming decade," added Crane. "National cancer centers should partner with their communities to do more to protect medically vulnerable populations, especially cancer patients."