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.
