Most recently, wildfires in Southern California have presented unprecedented challenges for cancer patients and their health care providers. Amid the chaos, oncology teams have demonstrated remarkable resilience and unwavering commitment, ensuring the continuity of care for their patients under the most difficult circumstances. Prompted by her own experience in 2020, recent research led by PGY5 Katie Lichter, MD, MPH, and her colleagues from University of California, San Francisco (UCSF), highlights the urgent need for cancer centers to develop disaster preparedness strategies to address the growing threat of wildfires, which are increasing in both frequency and severity.
Dr. Lichter’s journey into wildfire-related cancer care research began during her radiation oncology residency five years ago, when wildfires in Northern California disrupted patient treatments and outcomes. Moved by the impact on her patients, she co-founded the GreenHealth Lab at UCSF and spearheaded the first-ever study investigating how wildfires affect radiation therapy delivery and cancer survival rates. The research, supported in part by the Radiation Oncology Institute (ROI) – the ASTRO Foundation, has provided critical insights and actionable strategies for oncology teams to prepare for and respond to similar crises, whether environmental or other forces that threaten resources and continuity of care. She hopes that her work can help oncology teams be ready when they must act quickly and decisively as they did recently in Los Angeles County.
The Research Behind the Headlines
Admitting a lung cancer patient to the ICU during the 2020 Northern California wildfires was a turning point for Dr. Lichter. The patient had missed several weeks of chemotherapy and radiation due to wildfire-related travel disruptions, which ultimately compromised his treatment outcomes. This experience drove Dr. Lichter to investigate how wildfires impact cancer care delivery.
In her recently published study, “Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation” in Cancer Causes & Control, Dr. Lichter and her colleagues demonstrated that patients with Stage III non-small cell lung cancer who were exposed to wildfire disasters during treatment had worse overall survival than those unexposed. A forthcoming manuscript led by PGY4 Rachel Sabol, MD, PhD, further highlights significantly higher rates of missed radiation therapy visits during wildfire events (see the ASCO 2024 abstract).
Reflecting on her research and its implications, Dr. Lichter stated, "The growing number of wildfires across the U.S. has made it clear that oncology teams must be equipped to act quickly and decisively to protect their patients, especially those most vulnerable. My hope is to develop clinical toolkits for providers and patients that help identify risks early, streamline responses during disasters, and ensure continuity of care for those most at risk. With these resources, we can build resilience into cancer care systems and prevent disruptions like those we’ve seen during recent wildfire events."
These findings underscore the urgent need for actionable strategies to mitigate wildfire-related disruptions to cancer care. Supported by ROI, Dr. Lichter’s work offers a roadmap for oncology teams to enhance disaster preparedness and maintain uninterrupted patient care during wildfires and other natural disasters.
A look into one institution’s response: City of Hope's and the Eaton Fire
On January 8, 2025, the Eaton Fire broke out just eight miles from City of Hope’s main campus in Duarte, California, threatening not only the community but also the cancer center’s operations. Yun Rose Li, MD, PhD, assistant clinical professor in the Department of Radiation Oncology at City of Hope, shared how their team mobilized under extraordinary circumstances:
“As physicians and first responders, we at City of Hope are trained to respond and adapt to most emergencies. However, the recent wildfires brought unprecedented challenges and uncertainties for both patients and care providers. As our comprehensive cancer center leadership provided around-the-clock updates about our emergency loss of power, shelter-in-place orders due to extreme hurricane-level force winds and impending Los Angeles Fire Department notifications about local evacuations just miles down the road, our dedicated City of Hope team members reported to work to call patients and field questions about when their next treatment could be anticipated while leadership actively debated about the need to transport critically ill inpatients to nearby hospitals and the risk to our medical and research infrastructure. Within 24 to 48 hours, with the bravery and dedication of our staff, nearly all of our patients were able to resume treatments even as the Eaton fire raged on with 0% containment.”
“Many of our staff and faculty faced this situation in the face of their own adversity. Many City of Hope staff and faculty lost power, some have been evacuated, a number were displaced from their homes and some even lost their homes. As we recognize that the cadence of natural disasters is increasingly impacting our nation and the world, it is important that we as health care leaders develop emergency plans that allow clear and timely communications to patients and families, provide a system to appropriately triage those who are in need of urgent treatments or clinical assessment, and better support our first responders, who display the utmost bravery, composure, and compassion during a time of unfathomable uncertainty.”
The Eaton Fire, which has burned more than 14,000 acres, was 95% contained as of January 23, 2025. The City of Hope’s ability to maintain high-quality care amidst such adversity underscores the importance of preparedness and resilience in oncology practice.
Looking Ahead: Preparing for a New Reality
Anticipating unknowns is challenging, but preparing for a range of emergency scenarios can only be beneficial. Amidst unpredictable environmental factors, the radiation oncology community must adapt to protect patients and ensure care continuity. The Radiation Oncology Institute is proud to support researchers like Dr. Lichter, whose work not only advances our understanding of these challenges but also equips cancer centers with the tools they need to respond effectively.
By fostering collaboration between providers, researchers and institutions, the radiation oncology community can lead the way in building resilient systems that safeguard patient care, even in the face of climate-driven emergencies.
Additional Resources:
- American Cancer Society: Coping with Cancer After a Natural Disaster
- National Cancer Institute: Emergency Resources for the Cancer Community
- Americares: Climate Resilience for Frontline Clinics Toolkit
- U.S. Climate Resilience Toolkit: Climate Resilience for Health Care (CR4HC) Toolkit
Images courtesy of Dr. Li
