‘Call to action’: Research needed on impact of extreme weather events on cancer care
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Key takeaways:
- Researchers call for a standardized approach to evaluate the impact of extreme weather events on individuals with cancer.
- Studies are needed in biological, psychosocial, physical and behavioral outcomes.
Hurricane Ian hit Lisa M. Gudenkauf, PhD, MPH, hard.
She had started the process of moving apartments when Ian struck Florida as a Category 4 storm in September 2022. Gudenkauf had been in Miami but had to evacuate east. Then, she got stuck where she evacuated to because she could not get through Orlando due to flooding. The disaster even forced her to extend her previous lease to manage the aftermath.
Yet, Gudenkauf considers herself lucky. She had the resources to overcome the third costliest hurricane to ever hit the U.S.
Many, like individuals with cancer, did not.
“I couldn’t imagine if I had anything on top of just my normal life, trying to juggle all of that,” Gudenkauf, a research scientist in the department of health outcomes and behavior at Moffitt Cancer Center, told Healio. “It was really disruptive.”
That is why Gudenkauf and colleagues wrote a mini-review — published in Cancer Epidemiology, Biomarkers & Prevention — highlighting the need for more research on the impact extreme weather events like hurricanes may have on biological, psychosocial, physical and behavioral outcomes of those with cancer, as well as survivors.
“They’re evacuating and moving away and then getting blocked from transportation. Trying to get to treatment can be really challenging,” Gudenkauf said. “You hear patients describe loss of power and disruptions in getting their medications. All of these are critical components of a very well-timed cancer treatment regimen. It’s concerning that these [extreme weather events] get in the way, and it’s especially concerning that it differentially impacts patients depending on their area and socioeconomic status.”
Plenty of data exist on extreme weather events, including deaths, evacuees, cost of damages and more.
However, information is sparse regarding specific effects these catastrophes have on cancer survivorship, particularly due to lack of information pre- and post-disaster. With extreme weather events becoming more common, the need for standardized guidelines is essential, Gudenkauf said.
“Without that, we don’t really know how we can be proactive and what the plan is moving forward,” she explained.
“Risk and resilience’
Gudenkauf and colleagues reviewed published studies that investigated extreme weather events, noted their key findings and detailed multiple areas worthy of further investigation that could benefit cancer survivors.
Researchers discussed biological outcomes — specifically biological aging caused by stress. They described how stress increased inflammation and cellular metabolic activity, and how that could affect tumor microenvironments and potentially accelerate disease progression.
“It’s a bit of a hypothesis, but it’s being tested,” Gudenkauf said. “We want to have the biological data to be able to examine this. Do people have differential experience of aging in a biological sense because they’ve had this experience, or they were impacted even more greatly by extreme weather events than other people?”
Extreme weather events impact psychosocial outcomes as well. Notably, they can cause stress, insomnia, increased alcohol usage, depression, anxiety, mood disorders and even PTSD. All of these can impede cancer care and intensify symptoms.
“[Psychosocial stress is] worth measuring, particularly in the context of patient-reported outcomes,” Gudenkauf said.
“We can assume how people feel or what people experience, but what they report and how they say that it influences them is the most important predictor of future behavior and outcomes. ,” she added. “That’s why we have to ask patients directly what happened and how they feel about it. If we can get really good measurement of psychosocial outcomes, we feel confident that we could have a lot of helpful data that will guide development of interventions.”
Extreme weather events directly impact cancer care by disrupting community infrastructure such as transportation, electricity and health care services. Gudenkauf and colleagues noted Hurricane Maria caused treatment disruptions for 90% of cancer survivors in Puerto Rico.
They also detailed multiple risk and resilience factors and how extreme weather events do not impact all individuals the same, even if they live in the same community.
They described how individuals living in “high-rise, high-density public housing” did not experience the same recovery efforts as others during Hurricane Sandy, and how Black individuals had 86% higher likelihood of depression after Hurricane Katrina than white individuals.
“Social support is a strong predictor of people’s resilience or response to stress,” Gudenkauf said. “We want to make sure that people have a good social environment and the different types of social support that are predictive of success — emotional support, informational support, tangible support, people bringing you things or doing things for you — that are really going to make a difference in terms of how you cope with a stressor, how you prepare for a stressor.”
A standardized approach
Gudenkauf and colleagues recently submitted a grant application to compare pre- and post-hurricane data across a diverse group of individuals, examining patient-reported outcomes and biological outcomes using blood and saliva specimens.
They hypothesize that patients with cancer and cancer survivors will be impacted by extreme weather events more than the general population, including biological aging, increased inflammation, poor physical activity and sleep, more stress and anxiety, and all of these will result in worse outcomes.
“If we can measure those things in a standardized way within clinical practice, and we have a good handle on who’s at greater risk, we can target and support those individuals more in these situations — coming up with preparedness plans at the hospital level and knowing how we’re going to deal with disruptions and medical care,” Gudenkauf said.
They want a standardized approach that can be used across the country in any extreme weather event and hope other research groups join them.
“Whether it’s a hurricane, whether it’s a blizzard, whether it’s fires — the effects on biologic and psychosocial outcomes are actually very comparable, and that’s what we’re trying to assess and understand,” Gudenkauf said. “If we can apply the same approach across these different disasters or extreme weather events, we’ll have an advantage in preparing for and responding to those events. This is a call to action.”
For more information:
Lisa M. Gudenkauf, PhD, MPH, can be reached at lisa.gudenkauf@moffitt.org.
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Gudenkauf LM, et al. Cancer Epidemiol Biomarkers Prev. 2024;doi:10.1158/1055-9965.EPI-23-1029.
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