Kids are uniquely vulnerable to the health impacts of climate change. Kids who have had cancer, like my own daughter, seem to be that much more vulnerable. I can’t say for sure because there’s been almost no focus medically on this small—but growing—subset of the population.
Until now.
I was happily stunned by a recent article, “Climate Change Will Impact Childhood Cancer Risks, Care and Outcomes.” I’ve been dreaming someone would shed light on the specific climate vulnerability of kids with cancer and chart a path to support them. Full disclosure: the article is authored by doctors I have personally turned to with questions about possible impacts of climate-related extreme weather, wildfire smoke, and more on kids with cancer.
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There’s research available on environmental risk factors and pediatric cancer, of course. This article mentions air pollution and leukemia, pesticides and leukemia as well as central nervous system tumors, and even emerging research on a connection between high ambient temperatures in utero and childhood acute lymphoblastic leukemia. But the many studies I have poured over in the years since my daughter got sick uniformly stop there: at diagnosis.
This new article does not! It addresses impacts of global warming spanning the whole cancer care continuum—diagnosis but also the treatment phase plus the aftermath (oncologists call this phase “survivorship”). As in: “Climate-related changes may impact not only childhood cancer incidence but also outcomes and survivorship. A study of children and young adults with cancer in Utah reported that ambient air pollution, specifically PM 2.5 (or fine particulate matter) levels, was associated with increased cancer mortality in patients with lymphoma and central nervous system tumours.”
For a cancer mom endlessly searching for ways to safeguard my kid and kids like her, this article is a gift. I hope everyone reads it, not just cancer families. When we focus on the most vulnerable among us, I believe we stand to learn a lot about how to protect all of us. Yes, the article’s purpose is to better understand the challenges climate change poses to pediatric cancer patients and survivors and to identify ways to address this community. And yes, the audience for articles like this is pediatricians, and hopefully pediatric oncologists, not necessarily laypeople and caregivers, but having read it, I know it has a much broader audience.
Dr. Hannah Thompson, lead author and Assistant Professor in the Department of Environmental Medicine at the Icahn School of Medicine at Mount Sinai, agrees. “A variety of people do this work. It takes a team effort,” she says. Below are some of my takeaways after discussing the article with Dr. Thompson and her co-author and Mt. Sinai colleague Dr. Perry Sheffield, a pediatrician and co-director of the New York State Children’s Environmental Health Center (NYSCEHC).
Doctors need training in environmental health
Doctors aren’t trained in environmental health at medical school. This makes it tremendously difficult for them to help any family navigate impacts of global warming on human health. “Pediatricians aren’t equipped to help people when it comes to climate,” says Dr. Sheffield. “There is interest and concern, and clinicians don’t feel equipped to address it.” Mt. Sinai is helping by educating 10,000 people per year.
Beyond a lack of knowledge, it’s difficult to figure out what clinical medicine’s role is when advising families on climate impacts. It’s not something you can just write a prescription for. “Health care isn’t great about prevention,” says Dr. Sheffield, who is witnessing firsthand a “paradigm shift” in the general understanding that our global climate system and environment are related to children’s health. According to the article, “The American Academy of Pediatrics has emphasised the need for pediatricians to serve as advocates and collaborate with government entities and community programmes to protect children from the increasing risks of climate change.” Dr. Sheffield takes this a step further: “It is the responsibility of the healthcare system and clinicians to be working on it,” she says.
Vetted resources and partnerships can help
“Healthcare professionals who care for patients with pediatric cancer need additional educational resources and strategies to address these issues. Prevention strategies could include contingency plans for treatment when climate disasters, including flooding and hurricanes, affect patients… Currently available educational materials on environmental health best practices, such as air quality tools with action plans for poor air quality days … could be useful for patients to reduce hazardous exposures,” the article notes. Wildfire smoke exposure for a child who has had, say, lung radiation may well require a specific approach.
Good news: Educational materials are already available to help doctors guide their patients, says Dr. Thompson; groups mentioned in the article that are poised and ready to be strategic partners include national networks like the Pediatric Environmental Health Specialty Unit (PEHSU) and the Children’s Environmental Health Network, and especially the Childhood Cancer and the Environment Project through the PEHSU. Cancer organizations would do well to share resources like these with professionals and parents alike; the article states both communities are eager for help.
Caregivers can play a role
I’ve been told that clinicians worry about giving exhausted cancer families added work. But when it comes to environmental concerns, there’s a simple task I believe all parents and caregivers can easily handle: Ask questions about climate and environmental exposures at any and all doctor appointments. The more we ask, the more doctors will be prompted to do the work to be able to answer. This will move the needle on climate-literate clinicians.
A model is in the works
It was hard to choose one favorite part of this groundbreaking article, but here it is: a consultation team, the first in the United States, is currently in the works for an academic pediatric oncology hospital! This team would provide environmental health resources and risk reduction strategies to families asking questions during treatment or survivorship—a replicable model for any oncology floor. A dedicated consultation team would be a game changer for families.
More research is needed
More research on the threats climate change poses to patients with and survivors of childhood cancer is sorely needed, says Dr. Thompson. Many details in this article had to be extrapolated from research on climate impacts on adult cancer populations. “Imperative research questions remain,” says the article, including about climate-related exposures on pediatric cancer incidence and morbidity and mortality during survivorship, as well as about key points for climate-related interventions throughout the hell these kids endure that could improve health outcomes.
Funding is needed for studies that support healthy children
Funding in the United States is currently being taken away from, not given to, scientists, including those studying pediatric cancer. There’s no crystal ball to say how this will shift, but the authors of this article believe when the dust settles, support for kids’ health will remain.
“I think a majority of people in this country have an interest in protecting children’s health and an awareness that chronic illness, including cancer, has been on the rise and it’s too fast to be genetic changes,” explains Dr. Sheffield. “Every day, we are reminded of the importance of the environment to our individual and whole-country health.” I hope she’s right.