The impact of climate change on cancer care from the perspective of oncology nurses in low- and middle-income countries
Julia Challinor1 and Elaine Tomlins2
1School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, California, USA 94143
2The Royal Marsden NHS Foundation Trust, London SW63 6JJ, UK
Corresponding author: Elaine Tomlins Email: elaine.tomlins@rmh.nhs.uk
Welcome to this special issue on the impact of climate change on cancer care from the perspective of oncology nurses in Low- and Middle-Income Countries (LMICs).
This special issue was born in our network group, The Global Power of Oncology Nurses (GPON).
GPON connects oncology nurses from around the world, but focuses on those working in LMICs to offer a platform for their efforts and passion to deliver the best possible cancer care. They often work within circumstances of limitations in medications, medical technology, supplies and specialised workforce training, yet they treat more patients than all High-Income Countries put together. In the articles presented in this special issue, GPON shares the oncology nurses’ first-hand concerns about how climate change is impacting nursing practice and patients’ lives every day.
For instance, it will not have escaped your notice through the recent months that the world has been gripped with wildfires in Northern Africa and extreme floods in Pakistan as just two salient examples of climate change. Just imagine the challenges of delivering treatment or pain relief during those disasters.
The International Energy Agency agreed a mandate to limit increases in global mean temperature 1.5 times above pre-industrial levels but this requires massive investment and strong politics and is already failing [1]. The American Cancer Society produced a guide for policy makers in 2022 regarding organisational readiness for the impact of climate change [2] and you will read in this special issue how ill prepared the world is.
The special issue describes the impact of climate change on cancer care from the perspective of oncology nurses across six African countries (Ethiopia, Uganda, South Africa, Ghana, Cameroon and Nigeria), Colombia, the Republic of the Philippines, Turkey, Palestine and Lebanon.
Why is climate change of particular importance to nurses?
The health literature, international agencies (e.g., World Meteorological Organization), and governments have published warnings about the acute effects of climate change resulting in power shortages, supply chain failures, transportation and communication breakdowns. Only now are health authorities and experts identifying climate change as affecting the root causes of cancer due to environmental exposures to carcinogens, e.g., UV light, air pollution and contaminated water supplies.
Oncology nurses care for patients with cancer from prevention through end-of-life care or survivorship. Climate change is impacting their ability to do so, and the articles in this special issue identify their specific challenges and recommendations for governments and health care authorities to mitigate the negative consequences.
We hear from oncology nurses working in Colombia, Africa, Turkey, the Republic of the Philippines, and short editorials from oncology nurses in Palestine and Lebanon where climate change adds to the difficulties of political unrest and financial crisis. Droughts and extreme heat have decimated livestock and therefore livelihoods in Somaliland, Ethiopia, and Kenya and the consequences are pre-determinants of ill health including cancer [3]. Nigeria has experienced an increase in population activities that are contributing to climate change, e.g., farming, burning, mining. In Ethiopia, historical levels of flooding, warming and drought are exacerbated by climate change and affecting patients’ livelihood and ability to pay for their cancer care. An oncology nurse from Uganda and other African nurses highlighted the flooding, drought, and other weather changes that have resulted in decreased agricultural production and created food insecurity and increasing poverty leading to treatment abandonment. From South Africa and Uganda, the oncology nurses mentioned heightened skin cancer risk due to rising temperatures and increased exposure to UV light, due to patients’ farming and other outside work. A Cameroonian nurse worries about food insecurity and the effect on children with cancer. In Ghana, deforestation is a serious issue and is exacerbating climate change, and an oncology nurse from this country calls on governments to educate the public to reduce emissions leading to significant pollution and cancer risk. From Colombia, authors from an oncology nursing faculty in Valle del Cauca describe the context of climate change in the country, general health and national cancer incidence and care. Clinical oncology nurses from Antioquia and Valle del Cauca explain how they communicate with their patients about mitigating the effects of climate change on their health.
Extreme floods contaminate water supplies with carcinogens and indigenous populations living from the land are adversely affected causing mass migration and additional burdens to health systems. Oncology nurses from the Republic of the Philippines speak to these climate change impacts that also affect small island communities in the Pacific, Caribbean, and Indian Ocean. [4], [5]. They speak of a duty to care. Turkey has experienced more heatwaves, landslides, and extreme windstorms due to climate change and Palestine remains vulnerable to wastewater pollution and desertification [6] [7]. We hear from a Lebanese nurse who describes efforts to address climate change through a Governmental pledge but this has been thwarted and cannot be distanced from other crises such as financial instability and regional unrest. We learn how all these climate related changes are impacting cancer care by oncology nurses and for their patients.
What’s next
We, as oncology nurses, must continue to advocate for change but also ensure that we have organisational readiness for any impact that climatic change brings. The Multinational Association of Supportive Care in Cancer (MASCC) is currently conducting a global survey on health professionals' knowledge of climate change and we urge participation. This will be open until December 2024.
Nurses wishing to join (for free) the Global Power of Oncology Nurses should look to our website theglobalpowerofoncologynursing.com. We will continue to address climate change in our annual webinar during London Global Cancer Week each November, as well as in our publications going forward. We believe this is a truly global issue and nurses as the largest single health workforce are well situated to make a positive difference.
We hope you learn from the experiences of the LMIC oncology nurses who so eloquently describe their local and regional situations. Be concerned, inform yourself so you are able to advocate with facts and knowledge about the impact of our global crisis of climate change and cancer care. We thank all the authors for their time and passion about the subject and willingness to share with the larger oncology community.
References
1. IEA (2021) Net Zero Emissions by 2050: A Roadmap for the Global Energy Sector
2. Ismail E ( 2022) Conference proceedings https://theglobalpowerofoncologynursing.com/gpon-2022-programme/
4. https://public.wmo.int/en/media/press-release/climate-change-impacts-increase-asia
