# Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation

## TL;DR

Wildfire disasters during lung cancer radiotherapy are linked to worse survival outcomes, highlighting the need for healthcare adaptation strategies.

## Contribution

This study is the first to show a survival impact of wildfire disasters on lung cancer patients undergoing radiotherapy.

## Key findings

- Patients exposed to wildfire disasters during radiotherapy had worse overall survival (HR, 1.03; 95% CI 1.00–1.06).
- The study highlights the vulnerability of oncological treatments to extreme weather events.
- Adaptation strategies are needed to mitigate health risks from wildfires in cancer care.

## Abstract

Oncological treatments, such as radiotherapy, which requires consistent electricity, the presence of specialized clinical teams, and daily patient access to treatment facilities, are frequently disrupted by extreme weather events, posing several health hazards to patients. This study explores the association between declared wildfire disasters during radiotherapy and overall survival among patients with non-small cell lung cancer (NSCLC).

The study population consisted of 202,935 adults with inoperable Stage III NSCLC, who initiated radiotherapy from 2004 through 2019. Exposure was defined as a wildfire disaster declaration in the county of the treatment facility within 12 weeks of initiating radiotherapy. Overall survival was defined as the interval (months) between age at diagnosis and age at death, date of last contact, or study end. Cox proportional hazards was used to estimate crude and adjusted hazard ratios and 95% confidence intervals with inverse probability weighting.

Patients exposed to a wildfire disaster declaration during radiation treatment had worse overall survival (HR, 1.03; 95% CI 1.00–1.06; p = 0.02), compared to unexposed patients in adjusted models.

Exposure to a wildfire disaster during radiotherapy is associated with worse overall survival among patients with stage III non-operable NSCLC. This finding underscores the critical need for developing adaptation strategies within the healthcare sector, especially in oncology.