In 2022, Katie Lichter was a doctor in Northern California. She was walking home from work under orange skies due to the wildfires when she realized the connection between climate change and cancer treatment.
She had a patient who had advanced lung cancer and said his treatment was impacted by the fires – they were disrupting his ability to catch rides to his appointments for infusions and radiation. Eventually, she said her patient’s radiation oncology clinic shut down because of the fires.
“As I walked home, it was actually the day that we had the first orange skies in California, and [I] really started thinking about how maybe it wasn't a unique one-off story, but maybe things like a global pandemic, wildfires — maybe there's something to look into here,” Lichter said. She wondered if medical practitioners were overlooking how climate change could interrupt access to care, development of cancer and treatment outcomes.
Now at Dartmouth, Lichter is the inaugural director of Dartmouth Health’s new Division of Resilient and Sustainable Cancer Care at Dartmouth Cancer Center.
Her team is looking at how cancer treatment can impact the environment and how treatment can be impacted by climate change – much like the experience of her patient in California.
In New Hampshire Lichter says one snowy day this past winter resulted in 27 patients missing their radiation appointments.
Missed care, she said, correlates to how well patients survive.
“Patients do worse,” she said. “They have worse overall survival five years out.”
She said research has shown that recovery for patients who undergo cancer surgery during wildfires can be slower than people recovering with better air quality.
“Do patients have a harder time recovering because their bodies are stressed by other factors? Whether that's mental stress or actual stress from the poor air quality? We don't know. But all things that we're very interested in exploring further.”Dr. Katie Lichter
She said her and the team are tying together that local events, climate and weather are contributing more to cancer care, or lack thereof, than they had considered.
One method of study they’re pursuing is looking at medical records and weather data. Lichter said doctors can understand if risks to cancer are related to where they live, like if air quality is a factor in a patient’s cancer development and recovery.
Lichter said weather data, for example, typically isn’t included in patient records, but scientists could look back retrospectively at that kind of climate and environmental data to see how it might have contributed to disease.
The goal, for Lichter, is also to get proactive. For example, she’s wondering how providers can help patients get to their appointments in winter weather, or make sure appointments align better with their caregivers’ availability.
“I'm from Minnesota myself and we have this idea of community resiliency and what that means to live in a cold region,” Lichter said. “Is that true for the individual patient?”
Lichter said she is also interested in studying environmental factors that are found in New Hampshire, such as PFAS, and radon exposure. Both have been linked to elevated cancer risk.
Lichter and her team are also looking at whether the treatment of cancer itself can contribute to climate change.
Lichter points to how the medical industry uses lots of disposable, single use plastic items for hygiene.
“Not only do they create a lot of waste and processes that require incineration or burning of harmful toxins,” she said. “Are there other things that we are not really attuned to or turning a blind eye to and that includes chemotherapy drugs. What happens to the efflux of chemotherapy drugs?”
More broadly, one study Lichter authored showed that the healthcare industry contributes to 10% of the nation’s greenhouse gas emissions.
Lichter said her breast cancer patients wonder about the carbon footprint of cancer treatment and want to be able to help find ways to reduce climate impact through their cancer treatment.
“I think they're very altruistic,” Lichter said. “They feel very empowered by being able to also make a decision about their care or care that others may get down the road that could reduce harm.”
