Prioritizing Climate Hazard Preparedness Following NSCLC Surgery

Leticia Nogueira, PhD, MPH

American Cancer Society

Everyone is “in the same boat” when it comes to the inescapability of wildfires and other climate or environmental hazards. As a result, it is critical to prioritize research on adaptation and mitigation strategies to safeguard the health of patients recovering from surgery for non–small cell lung cancer (NSCLC) and other populations that may be vulnerable to these disasters, according to Leticia Nogueira, PhD, MPH.

Nogueira, scientific director of Health Services Research at the American Cancer Society, spoke with CancerNetwork^®, about the primary findings and implications of a study she published that assessed how wildfire exposure impacted post-operative length of stay (LOS) and surgical recovery among patients who received treatment for NSCLC.¹ Data showed that patients who recovered at a facility with exposure to wildfires experienced a longer average LOS compared with patients who underwent surgery at facilities during times when no climate disasters occurred.

“These types of disasters are going to keep going further in reaching people who never thought about this before. The sooner we all realize that nobody’s safe, that we’re all in the same boat here, we should be prioritizing our adaptation strategies [while] we’re considering our mitigation strategies,” Nogueira stated. “It will do the entire health care system, research population, [and even] everybody a favor the sooner we recognize that we need to be prioritizing this topic.”

Looking ahead, Nogueira highlighted that the next steps for research may include an exploration of how extended LOS may impact survival among this NSCLC population. Additionally, she described potential institution-based solutions for improving outcomes for patients with exposure to wildfires, emphasizing collaboration across different medical and research groups to spread knowledge regarding climate hazard preparedness and mitigation strategies.

CancerNetwork: What was the rationale for conducting this study assessing how wildfire events impacted LOS for patients undergoing surgery for NSCLC?

Nogueira: The rationale for this study was [based on] a previous study where we found that patients who were exposed to a wildfire after they were discharged from the hospital following lung cancer surgery had worse mortality than unexposed patients.² One question that we received a lot while we were discussing the results of that study was, “What can [doctors] do to protect these vulnerable people who are trying to recover from lung cancer surgery when there is a wildfire around them?”

Unfortunately, there were no clinical or even disaster guidelines that were specific for this population. But from talking to physicians and families, we saw that keeping the patients in the hospital for a couple of additional days was their best guess of what could be done. We decided to empirically test and conduct a study to see if, in the absence of guidelines—[because] there are no guidelines about what to do—would the physicians be implementing some of these improvisational strategies and keeping patients in the hospital a little longer anyways as their best guess of what could be done? That was the inspiration and the rationale for this study.

What did data show about how wildfire exposure affected LOS in this patient population?

In this study, we found that patients who were recovering from lung cancer surgery when there was a wildfire in the area ended up staying in the hospital for an additional 2 days on average [compared with] similar patients—same age, same gender, and same type of tumor who received the exact same type of surgery—but [when] there was no wildfire around them.

Were there any other striking findings that came from this research?

One thing that we were able to figure out is that these 2 additional days make a difference. First, shorter LOS is an established quality metric in the US, so it’s sometimes attached to payment incentives to the hospitals and physicians. It also costs approximately $1500 per day, on average, for each additional day the patient stays in the hospital, so there is a cost component.

But the most striking findings were in the previous study, where we found that patients who were exposed to a wildfire near their house for up to a year after being discharged from the hospital had worse overall mortality. The strongest findings were around 3 months, at 6 months, and up to a year, showing how hard it is to recover from this type of surgery. Lung surgery is involved and hard to recover from, showing that there is an urgent need for us to develop guidelines on how to better protect this patient population.

What are the next steps for researching how to further optimize LOS and other hospital resource utilization for this patient population, especially in the context of wildfires and other disasters?

The next steps for this specific patient population would be to test if staying in the hospital for a couple of additional days has an impact on survival. Does it make a difference? But similar to other disasters and other patient populations, what are any strategies that we can [implement] to better protect the health and safety of these people during a disaster? Is it staying longer in the hospital? Is it helping the patient, the caregiver, and the support network to create a disaster preparedness plan and evacuation plan? Is it a patient transfer agreement? Is it a recommendation to wear a mask?

We do not know because we have not studied it. The next steps would be to prioritize this type of research and work together to figure out what works and what doesn’t work. It might be different things for different types of disasters. A wildfire might be different than a flood, and different patient populations. Lung cancer vs leukemia might be completely different.

What should other institutions do or keep in mind to improve health care quality measures and develop specific disaster preparedness and response efforts?

Incorporating these contextual variables, we have this simplistic, straightforward [conclusion that] staying in the hospital for fewer days is better for the patient. But then you have all these contextual events that are happening around the patient that might mean something different, and maybe staying a little bit longer is better. Incorporating these contextual factors when trying to create or even develop the algorithm that’s going to come up with a number that measures quality of care is important.

Also, in a broader effort for health care institutions and research institutions to come together and prioritize this type of research on disaster risk management, we know that disasters are becoming more common. We know that their frequency, their intensity, and their behavior continue to change. The only way that we can figure out what’s going to work and what’s going to improve quality of care and patient outcomes is knowledge. Knowledge is power. We saw how big of a difference this made during the COVID-19 pandemic, where we had all these medical institutions, research [institutions], and other types of professionals coming together and saying, “This doesn’t work. This is one strategy we came up with to deal with this one problem.”

Prioritizing this type of research and understanding that all of us are a patient at some point, that we are all eventually vulnerable, [is important]. How can we better protect this entire population who is eventually going to need health care services? Also, how [do we] integrate lived experiences, these lessons learned from facilities that have gone through something like this previously, and find a better way of sharing that knowledge so that the next facility and the next patient population that gets impacted doesn’t have to reinvent the wheel or suffer the same consequences just because we weren’t able to share that knowledge?

What should others take away from the results of this study?

There is this inescapability, maybe, of climate hazards or environmental hazards in general. We’re seeing this frequently, and it’s spreading everywhere. We saw the wildfires in Los Angeles reaching places that they had never reached before. We saw Asheville being impacted by Hurricane Helene, a place that had been, at many times, named a climate haven. These types of disasters are going to keep going further in reaching people who never thought about this before. The sooner we all realize that nobody’s safe, that we’re all in the same boat here, we should be prioritizing our adaptation strategies [while] we’re considering our mitigation strategies. It will do the entire health care system, research population, [and even] everybody a favor the sooner we recognize that we need to be prioritizing this topic.

References

1. Nogueira LM, Yabroff KR, Yates E, Shultz JM, Valdez RB, Nori-Sarma A. Facility exposure to wildfire disasters and hospital length of stay following lung cancer surgery. JNCI. Published online March 11, 2025. doi:10.1093/jnci/djaf040
2. Zhang D, Xi Y, Boffa DJ, et al. Association of wildfire exposure while recovering from lung cancer surgery with overall survival. JAMA Oncol 2023;9(9):1214-1220. doi:10.1001/jamaoncol.2023.2144