Wildfire exposure linked to higher risk for death after lung cancer surgery
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Key takeaways:
- Exposure to wildfires within 3 months after NSCLC resection conferred a 43% higher mortality risk vs. no exposure.
- Prioritization of these patients in climate adaptation efforts is crucial, researchers wrote.
Patients exposed to wildfires while recovering from lung cancer surgery had worse survival outcomes than their unexposed counterparts, study results showed.
Researchers observed a significant increase in mortality risk up to 1 year after exposure to wildfires among patients with resected stage I to stage III non-small cell lung cancer, according to data published in JAMA Oncology.
“Hazards associated with climate change have created a dynamic state of vulnerability that will one day impact all of us — all it takes is one cancer diagnosis,” Leticia M. Nogueira, PhD, MPH, scientific director of health services research at American Cancer Society, told Healio. “We could be doing better at protecting the health and safety of patients who make up a medically vulnerable population to the health hazard posed by wildfires, which will only get worse with [continued] climate change.”
Background
Lung cancer surgery is often complicated and can lead to a challenging recovery, according to Nogueira. There are many obstacles to overcome during the postsurgical period, including cardiorespiratory, mobility, psychological and financial issues, she added.
“Beyond just inhaling smoke, we were interested to see how all of the factors that go into dealing with a wildfire impacted overall survival in recent lung cancer surgery recipients,” Nogueira said.
The motivation for the research came from Nogueira’s personal interest in the effects of the 2018 Paradise, California, wildfires on individuals with cancer. Teaming up with co-author Yang Liu, PhD, of Emory University, made the analysis possible, she said.
“This collaboration was transformative because it allowed us to use satellite data to measure wildfire exposure and combine it with cancer data that [American Cancer Society] had in house,” Nogueira said.
Methodology
Nogueira and colleagues conducted an epidemiologic cohort study to identify any association between wildfire exposure and long-term OS after surgical resection for lung cancer.
The analysis included 466,912 U.S.-based individuals from the National Cancer Database (mean age, 67.3 ± 9.9 years; 53.4% women) who underwent curative-intent surgery for stage I to stage III NSCLC between 2004 and 2019.
Investigators used ZIP code level-based data from NASA’s Fire Information for Resource Management System to determine exposure to wildfires in the patient’s area of residence within 0 to 3 months (n = 48,582; 10.4%), 4 to 6 months (n = 48,328; 10.6%) or 7 to 12 months (n = 71,735; 15.3%) after NSCLC surgery.
The researchers calculated mortality hazard by comparing patients whose residence overlapped with a wildfire event during the recovery period from their lung cancer surgery with mortality hazard among patients who resided in the same ZIP code but lacked exposure to a wildfire event during their surgical recovery.
OS — defined as the interval between age at hospital discharge and age at death, last contact or study end — served as the study’s primary outcome measurement.
Researchers used Cox proportional hazards models to produce estimated HRs that adjusted for sex, region, metropolitan location, health insurance type, comorbidities, tumor size, lymph node involvement, era (2004-2011 vs. 2012-2019) and facility type.
Median follow-up was 39 months (interquartile range, 17-74).
Key findings
Patients exposed to wildfires within 3 months of discharge for NSCLC resection had worse OS outcomes compared with unexposed individuals (adjusted HR = 1.43; 95% CI, 1.41-1.45).
Individuals exposed to a wildfire between 4 and 6 months (adjusted HR = 1.39; 95% CI, 1.37-1.41) and 7 and 12 months (adjusted HR = 1.17; 95% CI, 1.15-1.19) after hospital discharge also had worse OS outcomes than those unexposed to a wildfire.
Clinical implications
The negative impact of exposure to wildfires on OS for patients with lung cancer is not shocking, according to Nogueira. However, it surprised her group that the significantly higher risk for death — albeit a weaker one — persisted up to 1 year out from hospital discharge and across stages of resected NSCLC.
She believes clinicians can play a role in mitigating the additional risk, through tangible interventions ranging from recommending air filters to assisting with transfers to unaffected areas.
“As more of us are impacted by these extreme weather events or climate-driven disasters, there’s much more that we could be doing to protect the health and safety of patients by anticipating these vulnerabilities,” she told Healio. “Hospital directors need to use whatever resources are available to identify these patients when events occur and incentivize action.”
For more information:
Leticia M. Nogueira, PhD, MPH, can be reached at American Cancer Society, 3380 Chastain Meadows Parkway NW, S 200, Kennesaw, GA 30144; email: leticia.nogueira@cancer.org.
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