Climate Change and Evolving Threats to Public Health: The Oncology Nurse’s Role

Milagros Elia, MA, APRN, ANP-BC

According to the World Health Organization, climate change is the single biggest heath threat facing humanity today.¹ Unfortunately, the effects will be most keenly felt by vulnerable communities and patients with pre-existing conditions, including patients with cancer, according to Milagros Elia, MA, APRN, ANP-BC. Therefore, climate change is not just a health care issue, but an oncology nursing issue. Oncology nursing professionals need to understand how changes in local climates may affect how they care for their patients.

“For oncology nurses, it’s critical to understand who among our patients are at the greatest risk, and why, what makes them so vulnerable, and through what pathways,” Elia said.

Elia recently presented on the topic of climate change as part of the 2022 Oncology Nursing Society Bridge. After the presentation, Oncology Nursing News® met with her to gain a better understand of how the changing climate calls for action from oncology nurses.

As she noted in her presentation, climate events have the potential to disrupt core public health infrastructures and overwhelm health services.² Health systems are expected to remain at the front line and bear high costs from the growing number of extreme climate events.^3-7

Moreover, some of the poorest health systems in the United States are most likely to feel the effects of climate change since they have limited tools or resources to protect themselves. For example, communities such as the Navajo nation, who have limited indoor running water systems, and individuals living in places such as “Cancer Alley” in Louisiana are key examples of populations whose health conditions are directly tied to their local environments.

This also includes patients who live in geographically vulnerable areas, such as places susceptible to flooding, as this can cause issues including contaminated drinking water, food insecurity because of drought, an increase of vector borne diseases, transportation difficulties and consequent barriers to care. She noted oncology nurses should be cognizant of that fact that individuals of color and those who live in low-income communities traditionally experience systematically higher exposures to health threatening climate conditions.

“We are only as strong as our weakest link. In this case, that means the most vulnerable populations,” Elia said. She noted that this includes the very old, the very young, those experiencing treatment-related setbacks, or are at an increased risk of heatstroke or respiratory illness—such as patients with lung cancer or lung metastases.

“How do we allow for the continuation of care when we have an area that has been flooded?” Elia remarked. “Or [where there are] wildfires? Now we have barriers to access: there are trees down or there are [power] lines down. Patients don’t have access to their health care coming in. We don’t have universal structures in place to get around that.”

“In the short to medium term, the health [effects] of climate change are going to be determined [by] how much resilience have already [been] built into the current rate of climate change,” she said. “The effects will increasingly depend on the extent to what action is taken now to reduce emissions and avoid dangerous temperature thresholds and potential irreversible tipping points which we are coming rapidly up against.”

Of specific concern to Elia and other oncology nurse professionals, is the increase of global temperatures, as heat can take lives and affect health in a multitude of ways. Investigators with the National Aeronautics and Space Administration and National Oceanic and Atmospheric Administration have determined that the 10 hottest global years on record have been in the past 2 decades and that the summer of 2022 will be the coolest summer that we will have moving forward. As Elia pointed out, this is an intimidating threat to human health.

“Out of these climate threats, the biggest one we’re dealing with here in the United States and globally, is heat,” she said. “As nurses, we realize that extreme heat can take a toll on the body, and the increase of the risk of heat related illnesses and hospitalizations.”

Heat, when combined in an area with flooding, becomes a breeding ground for vector borne diseases, and mold and fungus entering homes. It also increases the risk of heat-related illnesses and hospitalizations. Moreover, heat waves may put individuals at greater risk of the effects of ultraviolet radiation. Elia noted that science has demonstrated that physical activity is a key factor in cancer prevention and is recommended during treatment, but for patients who live in cement cities with little greenspace, taking advantage of physical activity during heatwaves is challenging.

“Climate change is likely to affect cancer control actions, all along the cancer continuum, from increasing areas of exposure, etiology, and modifying behaviors for prevention and early detection all the way through detection, diagnosis and treatment and survivorship,” Elia summarized.

How can oncology nurses make a difference?

Nurses are the No. 1 trusted profession, and therefore, they are well-positioned to connect the dots for patients and families to help them understand the effect of their local environment, according to Elia.

“Our professional duties require that we assess and address our patients and their symptoms in clinical practice,” she said. “We provide them with resources to meet their needs.”

In her presentation at ONS, she highlighted some climate change scripts that oncology nurses may find useful in talking with their patients.

For example, patients who are socially isolated, are elderly, children, outdoor workers, have chronic comorbidities (ie, obesity, cardiovascular or lung disease, etc), or urban racial minorities with lower socioeconomic resources, may be at an increased risk of heat illness. To these patients and their caregivers, a nurse may say, “We are seeing more hot days every year in our area because of climate change and the heat can be tough for individuals with breathing problems or who are older. Let’s discuss ways to make sure you are prepared (ie, check heat index and outside earlier in the day), and options for getting a break from the heat if needed.”

Adults with cardiovascular disease and/or chronic pulmonary disease, and children with asthma are vulnerable to air pollution. To these patients and their caregivers, a nurse may say, “Climate change and air pollution are caused by the same thing: burning fossil fuels. Together they make air quality worse, and that can make heart and lung disease worse. Checking air quality and avoiding busy roadways when you go out for exercise can help protect you.”

To those with any underlying cardiovascular condition or respiratory disease is at risk of extreme weather conditions like wildfires. When addressing these patients, a nurse may say,

“Wildfires are becoming more common because of climate change. The smoke and particles can travel many miles and can be dangerous especially for individuals with heart or lung disease. It’s important to check air quality information when there are wildfires. Here is an online resource to help you do that and tips to reduce exposure.”

Elia added that there are multiple free apps to recommend to patients. “If our patients are having increased chronic respiratory symptoms, we can talk to them about governmental apps that have been developed to look at air quality that are free. We always want to empower our patients,” she said. “We give them [those] tools, make that connection for them and empower them to be self-sufficient.”

She noted that climate change is not going to be a conversation that all patients are receptive to; however, it is still the job of the oncology nurse to best equip their patients with the tools which will allow them to manage their health.

“Climate change is not going to be the topic that your patients necessarily are open to talking about,” she said. “It is not your job to sit there and try to convince them that all their new symptoms are because of climate change [or that they] become an advocate. That’s not why we’re here. We are here to support them.”

“You don’t need to use the word climate change with them—unless they’re open to that conversation. What you need to do is you need to address their symptoms and make the connection to their environment. So that it makes sense to them, and then give them the tools to help them deal with those symptoms. We take their lead.”

References

1. Climate change and health. World Health Organization. October 30, 2021. Accessed September 22, 2022. https://bit.ly/2SXgflM
2. Elia MR. Climate change and its impact on health. Presented at: ONS Bridge; September 13-15, 2022; virtual.
3. Nogueira LM, Yabroff KR, Bernstein A. Climate change and cancer. CA Cancer J Clin. 2020;70(4):239-244. doi:10.3322/caac.21610
4. Walker RK, Pereira-Morales S, Kerr R, Schenk E. Climate change should be on every nursing research agenda. Oncol Nurs Forum. 2020;47(2):135-144. doi:10.1188/20.ONF.135-144
5. Butterfield P, Leffers J, Vásquez MD. Nursing’s pivotal role in global climate action. BMJ. 2021;14(373):n1049. doi:10.1136/bmj.n1049. PMCID: PMC8201521.
6. Man RX, Lack DA, Wyatt CE, Murray V. The effect of natural disasters on cancer care: a systematic review. Lancet Oncol. 2018;19(9):e482-e499. doi:10.1016/S1470-2045(18)30412-1
7. Turner MC, Andersen ZJ, Baccarelli A, et al. Outdoor air pollution and cancer: an overview of the current evidence and public health recommendations. CA Cancer J Clin. 2020;10.3322/caac.21632. doi:10.3322/caac.21632