https://orcid.org/0000-0001-7348-4569
Abstract
Individuals diagnosed with cancer are a vulnerable population during disasters. Emergency preparedness efforts are crucial for meeting the health and safety needs of patients, health-care professionals, health-care facilities, and communities before, during, and after a disaster. Recognizing the importance of advancing emergency preparedness expertise to cancer control efforts nationwide, especially in the era of climate change, we searched National Cancer Institute–designated cancer centers’ websites to examine emergency preparedness information sharing and evidence of research efforts focused on disaster preparedness. Of 71 centers, 56 (78.9%) presented some emergency preparedness information, and 36 (50.7%) presented information specific to individuals diagnosed with cancer. Only 17 (23.9%) centers provided emergency preparedness information for climate-driven disasters. Informed by these data, this commentary describes an opportunity for cancer centers to lead knowledge advancement on an important aspect of climate change adaptation: disaster preparedness.
The ability of the health-care system to prepare and respond to disasters must continuously evolve to keep pace with increasing complexity and unpredictability of threats posed by climate change (1,2). In the current era of compounding hazards, such as those posed by the COVID-19 pandemic (3), structured information sharing and coordinated research efforts are crucial for continuously adapting to the ever-changing health and safety threats posed by climate-driven disasters.
More than 18 million individuals were living with a cancer diagnosis in the United States as of January 2022 (4), with nearly 2 million individuals newly diagnosed with cancer every year in the United States (2,5). The physical, psychological, and socioeconomic consequences of cancer diagnosis and treatment, combined with the requirement of frequent interactions with health-care professionals, result in unique needs and vulnerabilities for patients with cancer, survivors, caregivers, and health-care professionals (2). For example, patients with lung cancer whose facility was affected by a hurricane while they were undergoing radiation treatment had worse overall survival than similar patients who completed treatment at the same facility but at a time when no disasters affected the region (6).
The National Cancer Institute (NCI)–designated cancer centers are at the forefront of groundbreaking research and quality care delivery for individuals undergoing cancer treatment and survivorship care. These centers have greater access to resources through accreditation and are nationally distributed, collectively acquiring a range of emergency preparedness and response experiences for a variety of disasters (7). In addition, because of the multitude of health challenges presented by different cancer types and associated comorbidities (2,8), the expertise gained from tending to the specific needs of individuals diagnosed with cancer can inform disaster preparedness efforts for other medically vulnerable populations.
This commentary reports on current emergency preparedness information sharing and cancer-specific emergency preparedness research efforts identifiable through NCI-designated cancer centers’ websites. Informed by these data, we discuss the opportunities for cancer centers to lead the advancement of emergency preparedness expertise focused on medically vulnerable populations, a crucial component of cancer control that has implications for climate adaptation efforts nationwide.
Rapidly evolving emergency preparedness and response challenges
Climate change is the greatest threat to human health of our time (9). Climate change alters the frequency and behavior of extreme weather events, making it harder for communities to prepare and respond to increasingly unpredictable disaster circumstances that can damage medical infrastructure, trigger power outages, contaminate water sources, disrupt supply chains, and break transportation links, leading to potentially life-threatening interruptions in access to care (2,10). Therefore, climate change interferes with cancer control efforts throughout the cancer care continuum (2,11), from prevention (12), screening (13), and treatment (2,6,11) to survivorship care (14,15). In addition, as mentioned earlier, the physical, psychological, and socioeconomic consequences of cancer diagnosis and treatment make individuals diagnosed with cancer a vulnerable population to the health threats of climate change (2,16,17). Hence, to address the rapidly evolving challenges that climate change poses to cancer control efforts, ongoing and coordinated research and information sharing are needed to inform best practices for cancer care delivery during disasters.
Recognizing the threat that disasters pose to the US health-care system, the Centers for Medicaid & Medicare Services (CMS) started requiring all participating facilities, which includes all NCI-designated cancer centers, to have an emergency preparedness plan (18). Identifying disasters prevalent in the facilities’ catchment area is an important component of CMS’s emergency preparedness rule (18).
Following CMS’s recommendation, we used the Federal Emergency Management Agency’s (FEMA’s) presidential disaster declarations database to identify the types of disasters that are relevant within each NCI-designated cancer center’s catchment areas (19). We selected disasters that illustrate the rapidly evolving emergency scenarios in the era of climate change, including hurricanes, tropical storms, wildfires, and ice storms. Take hurricanes and tropical storms, for example. Climate change alters the behavior of hurricanes and tropical storms because a warmer atmosphere decreases the translational speed (forward motion) and increases the water capacity of these systems (10), which then stall over large metropolitan areas as they move onshore and can cause unprecedented flooding (20). Reliance on historical data is insufficient for anticipating the hazards that climate-driven storms pose, and communities are frequently unprepared for increasingly unpredictable circumstances (21). Similarly, wildfire activity, which is closely tied to temperature and drought (both altered by climate change), is increasing in the United States (22), leading to more frequent, intensified, and unanticipated circumstances in communities affected by wildfires (23). Finally, severe ice and snow storms were included because of increasing frequency that is intensified with climate-driven weakening of the temperature differential that stabilizes the polar vortex (24).
Extreme heat, the deadliest extreme weather event in the United States, is not included in FEMA’s presidential disaster declarations (19). Therefore, we were not able to evaluate the proportion of cancer centers exposed to this threat. Nonetheless, we included any emergency preparedness information about extreme heat in the web audit because patients with cancer are especially vulnerable to extreme heat (25), and heatwaves are frequently accompanied by power outages (resulting from increased electricity demand from air conditioners), which can lead to disruptions in treatments that are highly dependent on electricity (26).
Notably, even without being able to include extreme heat, we found that as of September 2022, all 71 NCI-designated cancer centers had been affected by at least 1 climate-driven disaster between 2015 and 2022 (Figure 1). In addition, patients with cancer residing outside NCI-designated cancer centers’ catchment areas are frequently transferred to these centers when disaster strikes. Therefore, the impact of climate-driven disasters on NCI-designated cancer centers is probably greater than the one estimated here using FEMA’s presidential disaster declarations and each center’s catchment area (Figure 1).
Federal Emergency Management Agency Presidential Disaster Declarations in NCI-designated cancer centers’ patient catchment areas, 2015-2022. Disaster and emergency data on climate-driven disasters (severe storms and tornados, floods, hurricanes, fires, severe ice and snow storms) occurring between 2015 and 2022 were collected from the Federal Emergency Management Agency (https://www.fema.gov/openfema-data-page/disaster-declarations-summaries-v2). Disaster data were linked to counties using the Federal Information Processing System code. Locations of NCI-designated cancer centers and patient catchment areas were obtained from the NCI website (https://www.cancer.gov/research/infrastructure/cancer-centers). NCI = National Cancer Institute.
Similar to the ubiquitous impact of climate-driven disasters, all NCI-designated cancer centers have been affected by the COVID-19 pandemic, which was declared a national disaster in March 2020 (27). The pandemic presented specific hazards and disruptions for individuals diagnosed with cancer, who are more likely to develop severe COVID-19, require hospitalization, be admitted into intensive care, require mechanical ventilation, and die from COVID-19 (28-31).
Showing a remarkable ability to respond quickly to challenging circumstances and to prioritize the health and safety of patients, different policies and strategies limiting person-to-person interactions to reduce transmission and accommodate the surge of health-care needs were swiftly implemented nationwide during the first months of the pandemic. Some of these measures complicated emergency preparedness and response efforts for climate-driven disasters, such as balancing the risk of COVID-19 infections with the need to congregate in shared spaces during evacuation and sheltering from climate-driven disasters (3). Nonetheless, the commonalities between challenges posed by different types of disasters also highlight the value in information sharing and knowledge advancement to enhance emergency preparedness and response efforts for medically vulnerable populations. For example, the modifications in radiation therapy regimens that were implemented in response to prolonged power outages in the aftermath of Hurricane Maria in Puerto Rico were later adopted during the first months of the COVID-19 pandemic (1,32).
Emergency preparedness information available in NCI-designated cancer centers’ websites
To identify current practices of emergency preparedness information sharing and expertise development among cancer centers in the United States, we searched all 71 NCI-designated cancer centers for potentially relevant terms. We chose to focus on NCI-designated cancer centers because they are distributed nationwide, are at the forefront of research on quality cancer care, and are a trusted source of information in the community (7). Further, all 71 centers are already required by CMS to have emergency preparedness plans (18).
The search function in each website link in the NCI’s directory for the 71 NCI-designated cancer centers was used to search for the following terms: climate, coronavirus/COVID/COVID-19, disaster, emergency (including searches for emergency preparedness plan, emergency management plan, emergency checklist, emergency generator, emergency operations, and emergency supplies), flood, hazard, heatwave, hurricane, preparedness, risk, storm, tornado, vulnerable/vulnerability, weather, and wildfire. Search results for each term were reviewed for the presence of 1) relevant general information about emergency preparedness and 2) cancer-specific emergency preparedness information.
As of September 2022, the majority (56 [78.9%]) of centers provided general emergency preparedness information, and approximately half (36 [50.7%]) provided cancer-specific emergency preparedness information (Figure 2, A). Demonstrating remarkable ability to respond quickly to challenging circumstances, NCI-designated cancer centers began providing information about how COVID-19 spread could affect operations on March 3, 2020 (33), a week before the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, and a nationwide presidential disaster was declared on March 13, 2020, in the United States (27). As of September 2022, the majority (53 [74.6%]) of centers provided general emergency preparedness information about the COVID-19 pandemic, and nearly half (32 [45.1%]) provided cancer-specific emergency preparedness information about the pandemic (Figure 2, A). The rapid response to the pandemic demonstrates the ability of the health-care system to dedicate necessary resources to adapt to threats that are considered a priority.
Percentage of National Cancer Institute–designated cancer centers with available emergency preparedness information on their websites. A) Emergency preparedness information (any information, COVID-19 pandemic specific, and climate change specific). B) Relevant emergency preparedness information identified when using the term emergency or disaster. C) Relevant information on vulnerabilities (older age, chronic health conditions, etc) or mental health consequences of disasters. D) Information about emergency preparedness steps that individuals can take or that institutions are taking.
In contrast, using the same method, we found that fewer than 1 in 4 centers’ websites (17 centers [23.9%]) provided general emergency preparedness information about climate-driven disasters, and only 7 centers (9.9%) provided cancer-specific emergency preparedness information about climate-driven disasters (Figure 2, A). The lack of similar urgency and resource mobilization in response to climate change is surprising because climate change is the greatest threat to human health of our time (9).
One key finding was that although the NCI website already provides general emergency resources for the cancer community (34), none of the 71 NCI-designated cancer centers provided general or cancer-specific emergency preparedness information in a similar centralized format. Searching for the term emergency yielded the highest number of relevant results (15 websites [21.1%]). Among these, only 4 (5.6%) had cancer-specific emergency preparedness information (Figure 2, B). Identifying relevant “emergency preparedness” information was cumbersome; however, because of the high number of search results with “emergency department” information. Moreover, only 10 (14.1%) of the websites yielded a relevant result when searched for the word disaster, and only 3 (4.2%) websites provided cancer-specific emergency preparedness information when the word disaster was used (Figure 2, B).
When present, emergency preparedness information included health hazards of disasters to the general population and specific vulnerabilities of individuals diagnosed with cancer, links to external resources, steps individuals can take, steps the institutions were taking to prepare and respond to disasters, and lessons learned from previous experiences.
Hazards and vulnerabilities
A critical step in developing emergency preparedness plans is the ability to strategize the timely deployment of adequate assistance to individuals, which varies according to the hazards posed by different types of disasters as well as the vulnerabilities of the population (18). Further, communicating hazards, vulnerabilities, and emergency preparedness information to patients, caregivers, and staff is crucial because it can improve individual self-efficacy and community resilience (35,36).
Relevant emergency preparedness information can be provided through different channels, including social and digital media (cancer centers’ websites), print media (posters, flyers, etc), and interpersonal communication (at health-care visits). Although the present study was able to evaluate only the information available on cancer centers’ websites, previous studies have reported on the dearth of emergency preparedness information being shared with patients who have cancer (37).
Of the 71 NCI-designated cancer centers’ websites evaluated, only one third (24 centers [33.8%]) provided information about characteristics associated with increased vulnerability to the health threats of the pandemic or climate-driven disasters, such as older age and the presence of underlying medical conditions (Figure 2, C). Moreover, only 16 centers (22.5%) provided information about vulnerabilities specific to individuals diagnosed with cancer. Examples included how exposure to wildfire smoke can adversely affect individuals diagnosed with lung cancer and how individuals undergoing cancer treatment may be more susceptible to infections that are common during flooding events (Figure 2, C) (38-40).
The health hazards and vulnerabilities posed to patients with cancer, caregivers, and health professionals go beyond physical health. Exposures to trauma, loss, and life changes before, during, and after disasters pose risks for psychological distress and new-onset psychiatric disorders (41,42). Providing mental health and psychosocial support is crucial for keeping frontline workers healthy and resilient and for providing timely psychological assessment and psychosocial intervention for disaster survivors (43). Only 17 (23.9%) NCI-designated cancer centers’ websites provided information and resources on stress associated with disasters (all of which were about the pandemic), including information for health-care workers (44,45), and only 11 (15.5%) centers provided stress and mental health information specific to individuals diagnosed with cancer (Figure 2, C). Even more concerning, among these, only 1 center provided information about maintaining psychological health and well-being during climate-driven disasters (ie, hurricane season) (46).
The implication of these findings is that NCI-designated cancer centers have an opportunity to lead knowledge advancement on the physical and mental health vulnerabilities of individuals diagnosed with cancer in the context of disasters, with the potential to improve individual efficacy and inform emergency preparedness efforts that protect the health and safety of medically vulnerable populations.
External resources
Demonstrating the ability of health-care professionals to engage in structured information sharing and coordinated research efforts globally when an issue is prioritized, links to external resources providing information about the COVID-19 pandemic included global organizations, such as the United Nations and the WHO; US federal government organizations, such as the Centers for Disease Control and Prevention and the NCI; local organizations, such as county and city government resources; and nonprofit organizations such as the American Cancer Society, the American Society for Clinical Oncology, and the National Comprehensive Cancer Network.
Similarly, external resources with relevant information about emergency preparedness for climate-driven disasters included links to global organizations, such as the Red Cross; US federal government organizations, such as FEMA (47,48), the NCI (49), and the Department of Homeland Security (50); nonprofit organizations, such as the American Cancer Society (51); and local resources, such as county-specific extreme weather alert systems (46,52-54).
Among these, only the American Cancer Society and NCI websites provide emergency preparedness information specific to individuals diagnosed with cancer, including unique vulnerabilities, guidelines for creating a portable medical card, and recommendations for getting extra supply of medicines. Further, both the NCI and American Cancer Society websites recommend individuals diagnosed with cancer talk with their health-care professionals about creating a disaster plan (34). Therefore, NCI-designated cancer centers have an opportunity to build on existing resources and advance the knowledge base used to inform the development of cancer-specific emergency preparedness resources.
Individual-level emergency preparedness information
NCI-designated cancer centers’ websites that contained any emergency preparedness information provided information about steps that individuals can take in an emergency (17 [23.9%]), such as how to create general disaster preparedness plans, items to be included in emergency supply kits, how to create evacuation plans, how to shelter in place safely, and how to arrange for safety of pets (Figure 2, D) (39,40,46,47,49,52,54-64). Fewer centers (4 [5.6%]) provided information specific to individuals diagnosed with cancer (Figure 2, D), such as how to preregister for special-needs shelters (53,60), how to request additional medical supplies before disaster strikes (38), how to create a portable medical card with diagnosis and treatment information (38,49), and how to stock ample quantities of cancer treatment–related items in an emergency supply kit (eg, sanitizing supplies for increased risk of infections while undergoing cancer treatment and medications to manage side effects of cancer treatment) (38,49).
Providing such resources to individuals and communities facilitates the ability of individuals to take actions to prepare, adapt, and withstand an emergency or disaster. As mentioned earlier; however, the physical, psychological, and socioeconomic consequences associated with cancer diagnosis and treatment can decrease the adaptive capacity of individuals. Therefore, it is vital that cancer centers also engage in emergency preparedness and response efforts at the institutional level.
Institutional-level emergency preparedness information
Some aspects of institutional-level emergency preparedness efforts involve sensitive or confidential information (eg, patient transfer agreements, guidelines for sheltering in place during a terrorist attack, incident command system) that cannot be shared with the public. Therefore, we expected information shared on websites regarding institutional-level emergency preparedness efforts to be limited and focused our search on nonconfidential components of institutional-level emergency preparedness.
Several centers’ websites provided information about steps the institutions were taking to respond to the pandemic, such as adapting the supply chain to the increased need for personal protective equipment (65), implementing new safety measures (eg, requiring patients to wear a mask and to keep 6 feet between individuals) (66,67), changing visitor policies (66), and shifting to telemedicine (65,68-78), demonstrating the ability of the health-care system to swiftly and continuously adapt to concerns that are prioritized.
In contrast, few centers provided information about institutional-level emergency preparedness efforts relevant to climate-driven disasters (8 [11.3%]), of which half provided information relevant to patients with cancer (4 [5.6%]), including information about facilities’ efforts to consolidate appointments to minimize the time patients with lung cancer have to spend outside during wildfires and how disasters could affect cancer treatment schedules (Figure 2, D) (38,39,63,79).
Further, only 2 cancer centers provided information about lessons learned from previous experiences implementing emergency preparedness plans during a climate-driven disaster, in op-ed or interview format (80,81). After establishing that all NCI-designated cancer centers had been affected by a climate-driven disaster (Figure 1), the dearth of information about lessons learned from previous experiences preparing and responding to climate-driven disasters was especially concerning. As climate change continues to alter the frequency and behavior of extreme weather events, cancer centers nationwide are affected by disasters that present unfamiliar threats with increasing frequency. Therefore, timely, structured, postdisaster evaluation and information sharing are essential for national adaptation efforts and the knowledge gained should not be confined to the affected facility (82).
In addition to structured postdisaster evaluation and information sharing, a collaborative research effort to advance scientific knowledge on cancer-specific emergency preparedness and response strategies is needed to meet the challenges presented by a changing climate. One such effort, focused on a different medically vulnerable population (pediatric patients), was identified in the present study (83). Therefore, there is precedent for collaborative research aimed at protecting the health and safety of medically vulnerable populations in disasters.
A road map for cancer-specific emergency preparedness research
Recent climate-driven extreme weather events have demonstrated the need to advance knowledge and expertise about climate-proofing health-care operations (84). With climate change, the hazard profiles of disasters affecting health-care institutions are constantly changing, as are available and feasible solutions. Similar to cancer treatment advancements, emergency preparedness is a rapidly evolving field, and NCI-designated cancer centers are well positioned to lead knowledge advancement on cancer-specific emergency preparedness efforts (85).
First, CMS already requires that all participating facilities and health-care systems, which includes all NCI-designated cancer centers, have an emergency preparedness plan (18). Therefore, this would not be a de novo effort. Instead, centers could start by evaluating how current CMS-compliant emergency preparedness plans address the specific needs of individuals diagnosed with cancer and how plans perform in protecting the health and safety of this medically vulnerable population when disaster strikes.
Second, NCI-designated cancer centers can build on existing resources for centralized information sharing, such as the NCI’s “Emergency Resources for the Cancer Community” (34), which provides information about disaster preparedness for the cancer community; the American Cancer Society’s guide to getting ready for a natural disaster (51); and the Department of Homeland Security’s website (50), which provides hazard-specific information and guidance for actions before, during, and after disaster strikes as well as links to other federal and local resources (50).
Providing individuals and communities with information and resources facilitates actions to prepare, adapt, and withstand an emergency or disaster (35,36). Core emergency preparedness capabilities; however, must continuously evolve to meet the challenges posed by a rapidly changing climate with more frequent, overlapping, and unfamiliar hazards that create new risks and exacerbate existing vulnerabilities (86,87). Therefore, structured mechanisms for sharing lessons learned while developing and implementing emergency preparedness plans between health care institutions are urgently needed. In addition to structured information sharing, coordinated research efforts that facilitate data sharing, hypothesis testing, teaming, and implementation science are all necessary for meaningful knowledge advancement on climate adaptation strategies. Further, research is needed to ensure that emergency preparedness information is communicated in a timely, clear, accessible, and actionable way that goes beyond website content.
A coordinated research effort would involve enhanced surveillance to identify vulnerable populations and track financial, physical, and psychological consequences resulting from exposure to climate-driven disasters among patients, caregivers, communities, health-care professionals, and institutions. Enhanced surveillance would facilitate research that can inform fine-tuning of emergency preparedness plans. For example, 1 study found that the temperature thresholds for heat alerts, which are used to inform vulnerable populations of extreme heat risks, were set about 20 degrees too high compared with the temperature at which peak hospitalizations occur in parts of the United States (110° vs 90°) (88). Coordinated evidence gathering and interinstitutional collaboration would allow NCI-designated cancer centers to evaluate public health and emergency preparedness interventions relevant to individuals diagnosed with cancer, determine efficacy, and document weaknesses to identify areas for potential improvement (89).
Because of discriminatory policies and practices, communities already experiencing cancer disparities are also more vulnerable to the threats of climate-driven disasters (90). Because individuals from communities targeted for marginalization are affected first and most by the threats of climate change (91), integration of community expertise in emergency preparedness research efforts is essential for continuously identifying modifiable risk factors and developing inclusive strategies to ameliorate health sensitivities, facilitate access to care, and improve adaptive capacity for the entire population (92). The Centers for Disease Control and Prevention’s Social Vulnerability Index, which was created to “help emergency response planners and public health officials identify communities that will most likely need support before, during, and after a hazardous event” (93), can help oncology professionals identify and engage with community experts. Community expertise can also inform strategies for effectively relaying emergency preparedness information using culturally and linguistically appropriate approaches that match the needs of different vulnerable populations (eg, individuals diagnosed with cancer, people with limited English proficiency, communities with limited access to warning systems). Further, by integrating the expertise coming from affected communities to address overlapping social vulnerabilities, coordinated research on emergency preparedness will contribute to health equity.
Finally, coordinated research efforts that integrate community expertise would facilitate identification and implementation of strategies that have emergency preparedness, climate mitigation, and public health co-benefits. For example, exposure to pollution from diesel-powered emergency generators was a main concern among patients with cancer in the aftermath of Hurricane Maria in Puerto Rico (15). With climate change, power outages are becoming more common, increasing the risks of exposure to air pollution and carbon monoxide poisoning from diesel-powered emergency generators nationwide (94). Therefore, the recent categorical waiver issued by CMS allowing health-care facilities to use health-care microgrid systems for emergency power builds on lessons learned in Puerto Rico and has climate adaptation, mitigation, and public health co-benefits because it contributes to disaster preparedness (decreasing reliance on transportation of diesel fuel to affected areas), reduces emissions (removing an important regulatory obstacle to clean energy uptake among health-care facilities), and improves public health (decreasing exposure to pollution in affected communities) (95).
Similarly, the Inflation Reduction Act provides several options and opportunities for health-care systems to adopt climate-mitigation strategies that have disaster adaptation and public health co-benefits (96). Recognizing the contribution of the health-care system to the climate crisis (97), 2 centers provided information about sustainability efforts on their websites (98,99). One center mentioned how reduction in emissions because of the shift to telehealth and teleworking during the pandemic has climate change co-benefits, illustrating how lessons learned from the rapid mobilization of resources, information sharing, and modifications that were implemented in response to the pandemic can serve as a template for our response to the health threats of climate change (100). Similarly building on the connection between disaster preparedness for the pandemic and for climate-driven disasters, FEMA announced in August 2021 that recipients of disaster declarations in response to the COVID-19 pandemic are eligible to invest up to 4% of the funds in mitigation efforts to reduce risks from climate-driven disasters (27).
Discussion
Emergency preparedness plans are critical for mitigating hazards and diminishing the detrimental consequences of crisis situations, and individuals diagnosed with cancer are a vulnerable population with distinctive needs that require special considerations. Every NCI-designated cancer center has been affected by the national COVID-19 pandemic disaster declaration in the past 2 years, and every NCI-designated cancer center has been affected by a climate-driven disaster in the past decade. Although the majority of NCI-designated cancer centers provided emergency preparedness information about the pandemic on their websites, fewer than 1 in 4 provided emergency preparedness information about climate-driven disasters. Moreover, less than 10% of centers provided cancer-specific emergency preparedness information related to climate-driven disasters.
As climate change makes it harder for patients, health-care professionals, and communities to prepare and respond to increasingly unpredictable disaster circumstances, knowledge advancement and information sharing are vital tools for protecting the health and safety of patients, caregivers, staff, and institutions. A nationwide structured and timely emergency preparedness information sharing system and a coordinated, cancer-specific emergency preparedness research initiative are both vital for advancing cancer control efforts in the era of climate change (82). A coordinated research effort would also facilitate identification of climate adaptation strategies that have greenhouse gas emissions and public health co-benefits.
NCI-designated cancer centers are at the forefront of research and provision of quality cancer care, with greater access to resources through accreditation. These centers are distributed nationwide, with established relationships with other health-care institutions, are trusted health entities within their communities, and are already required by CMS to develop emergency preparedness plans focused on the vulnerability of their patient population (18). In addition, because of the wide-ranging medical needs and high prevalence of comorbidities among individuals diagnosed with cancer, the knowledge that NCI-designated cancer centers generate could inform emergency preparedness and response efforts for other medically vulnerable populations, including immunocompromised individuals, those with cardiorespiratory sensitivities, and those with thermoregulation difficulties.
This study reports on current information-sharing strategies and research efforts identified on NCI-designated cancer centers’ websites, setting a baseline against which progress can be measured. Further, we recognize that although NCI-designated cancer centers are well positioned to lead information sharing and collaborative research aimed at continuously improving emergency preparedness and response efforts nationwide, other institutions (such as the American College of Surgeons’ Commission on Cancer and the American Society of Clinical Oncology) also provide accreditation to cancer centers in a manner that would facilitate emergency preparedness information sharing and coordinated research efforts.
Conclusion
Every NCI-designated cancer center has been affected by a climate-driven disaster in the past decade and by the COVID-19 pandemic in the past 2 years. Although most centers provided pandemic-related emergency preparedness information on their websites as of September 2022, few provided emergency preparedness information related to climate-driven disasters. As cancer centers nationwide are more frequently affected by disasters that present unprecedented hazards resulting from climate change, a national structured and strategic emergency preparedness information-sharing and coordinated research effort is vital for protecting the health and safety of patients with cancer, caregivers, health-care professionals, and institutions. As the leaders in cancer research and quality care; NCI-designated cancer centers are well positioned to engage in efforts to advance knowledge on emergency preparedness efforts that protect the health and safety of medically vulnerable populations.
Data availability
All data used in the article are publicly available.
Author contributions
Zelde Espinel, MD MA MPH (Data curation; Formal analysis; Writing—original draft; Writing—review & editing), James Shultz, MS PhD (Conceptualization; Writing—original draft; Writing—review & editing), Vanina Aubry, MD (Data curation; Formal analysis), Omar Abraham, MD (Data curation; Formal analysis), Qinjin Fan, PhD MS (Data curation; Formal analysis; Writing—review & editing), Tracy Crane, PhD RDN (Writing—review & editing), Liora Sahar, PhD GISP (Conceptualization; Writing—original draft; Writing—review & editing), Leticia Nogueira, PhD, MPH (Conceptualization; Data curation; Formal analysis; Writing—original draft; Writing—review & editing).
Funding
No funding was used for this study.
Conflicts of interest
L.M.N., who is a JNCI Associate Editor and co-author on this paper, was not involved in the editorial review or decision to publish the manuscript. The authors have no conflicts of interest.
