Climate change and evolving public health threats: the role of the oncology nurse

According to the World Health Organization, climate change is the greatest health threat facing humanity today.1 Unfortunately, the effects will be felt most harshly by vulnerable communities and patients with pre-existing conditions, including cancer patients, 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 local climate changes can affect the way they care for their patients.

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

Elia recently gave a presentation 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 better understand how climate change is calling oncology nurses to action.

As she noted in her presentation, climate events have the potential to disrupt key public health infrastructure and overwhelm health services.2 Health systems should remain on the front line and bear the high costs of the increasing number of extreme weather events.3-7

Additionally, some of the poorest health systems in the United States are most likely to feel the effects of climate change because they have limited tools or resources to protect themselves. For example, communities such as the Navajo Nation, which have limited inland running water systems, and people living in places such as “Cancer Alley” in Louisiana are key examples of populations whose health conditions are directly related to their local environment.

This also includes patients who live in geographically vulnerable areas, such as areas prone to flooding, as this can lead to issues such as contaminated drinking water, food insecurity due to drought, increased disease vector-borne diseases, transport difficulties and consequent obstacles to care. She noted that oncology nurses should be aware that people of color and those living in low-income communities have traditionally been consistently more exposed to health-threatening weather 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 those at increased risk of heat stroke or respiratory disease, such as patients with lung cancer or lung metastases. .

“How can we allow continued care when we have an area that has been flooded?” remarks Elia. “Or [where there are] Forest fires? Now we have barriers to access: there are downed trees or there are [power] lines down. Patients do not have access to their health care. We don’t have any universal structures in place to get around that.

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

Rising global temperatures are of particular concern to Elia and other oncology nurses, as heat can kill lives and affect health in myriad ways. Investigators from the National Aeronautics and Space Administration and the National Oceanic and Atmospheric Administration have determined that the 10 hottest global years on record have occurred in the past 2 decades and that the summer of 2022 will be the hottest summer. fees we will have in the future. As Elia pointed out, this is a daunting threat to human health.

“Of these climate threats, the most significant that we face here in the United States and around the world is heat,” she said. “As nurses, we realize that extreme heat can have adverse effects on the body and increase the risk of heat-related illnesses and hospitalizations.”

The heat, when combined in a flooded area, becomes a breeding ground for vector-borne diseases and the ingress of mold and fungus into homes. It also increases the risk of heat-related illnesses and hospitalizations. In addition, heat waves can put individuals at increased risk of the effects of ultraviolet radiation. Elia noted that science has shown that physical activity is a key factor in cancer prevention and is recommended during treatment, but for patients who live in cement towns with few green spaces, take advantage of the Physical activity during heat waves is difficult.

“Climate change is likely to affect cancer control actions, along the cancer continuum, from increased areas of exposure, etiology and behavior modification to prevention and early detection. until detection, diagnosis, treatment and survival,” summarized Elia.

How can oncology nurses make a difference?

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

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

In her presentation to the ONS, she highlighted some climate change scenarios that oncology nurses might find useful to talk about with their patients.

For example, socially isolated patients, the elderly, children, outdoor workers, chronic comorbidities (i.e. obesity, cardiovascular or pulmonary disease, etc.), or urban racial minorities with lower socio-economic resources may be at increased risk of heat illnesses. To these patients and their caregivers, one nurse can say, “Each year we see more hot days in our area due to climate change and the heat can be difficult for people with respiratory problems or who are older. Let’s discuss ways to make sure you’re prepared (i.e., check the heat index and outdoors earlier in the day) and options for getting a break from the heat if needed.

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

For those with underlying cardiovascular disease or respiratory disease, they are exposed to extreme weather conditions like wildfires. In addressing these patients, a nurse may say,

“Forest fires are becoming more frequent due to climate change. The smoke and particulates can travel for many miles and can be dangerous, especially for people with heart or lung conditions. It is important to check air quality information when there are wildfires. here is a online resource to help you do this and tips for reducing exposure.

Elia added that there are several free apps to recommend to patients. “If our patients have increased chronic respiratory symptoms, we can tell them about the government apps that have been developed to look at air quality and are free. We always want to empower our patients,” she said. “We give them [those] tools, make that connection for them and empower them.

She noted that climate change will not be a conversation that all patients will be receptive to; however, it is always up to the oncology nurse to best equip her patients with the tools to manage their health.

“Climate change is not going to be the topic your patients will necessarily be open to talking about,” she said. “It’s not your job to sit around and try to convince them that all their new symptoms are due to climate change. [or that they] become a lawyer. 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 this conversation. What you need to do is treat their symptoms and make the connection to their environment. To make it meaningful to them, then give them the tools to help manage these symptoms. We take their example. »

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 to: 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 Nurses Forum. 2020;47(2):135-144. doi:10.1188/20.ONF.135-144
  5. Butterfield P, Leffers J, Vasquez MD. The Central Role of Nursing 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 current evidence and public health recommendations. CA Cancer J Clin. 2020;10.3322/caac.21632. doi:10.3322/caac.21632

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