There is abundant evidence that climate change and the related pollution of our environment from fossil fuels will significantly ­­­impact our ability to treat and care for cancer patients. (Wise, 2021). The intent of this statement is to affirm the commitment of the following oncology health professionals to addressing the impact of climate change on cancer care and outcomes.
 
Air pollution 

• Air pollution, caused by the burning of fossil fuels or wildfires, is estimated to have caused hundreds of thousands of lung cancer deaths annually worldwide. (Turner, 2020). The Global Burden of Disease study attributes 15% of all lung cancer deaths to PM2.5 from outdoor air pollution  (Global Burden of Disease, 2016) (Global Burden of Disease, 2017)
• The International Agency for Research on Cancer (IARC) classified outdoor air pollution and particulate matter less than 2.5 micrograms/meter3 (PM2.5) as carcinogenic to humans (Loomis, 2013)
• Air pollution can cause lung cancer even in people who have never smoked  (Swanton, 2022) (Turner, 2020).
• People with lung cancer who are exposed to air pollution have an increased mortality from lung cancer.  (Hamra, 2014)  (Eckel, 2016) (Ou, 2020)
• Exposure to air pollution has been associated with the promotion of lung cancer by acting on cells in healthy lung tissue  that harbour pre-existing oncogenic mutations  by activating macrophages to release IL- 1beta (Swanton, 2022), particularly in those living in polluted neighborhoods (Erhunmwunsee, 2021)

Extreme weather events have a major impact on access to cancer care

• Disruptions due to hurricanes resulted in worse outcomes in patients with Stage 3 NSCLC undergoing definitive radiotherapy   (Nogueira, 2019)
• Treatment delays or interruptions for breast, colorectal, head and neck cancers, and gynecological cancers can result in worse survival outcomes (Man, 2018)
• Infrastructure damage due to flooding can result in loss of power, electricity, water, radiotherapy equipment, clinical facilities, medical records and access to staff, as evidenced by Hurricane Katrina in 2005. (Man, 2018)
• Interruption of drug supply chains and consequent shortages, as occurred in 2018 when Hurricane Maria struck Puerto Rico which caused the closure of factories that supplied the bulk of small volume IVs in the continental US ((Man, 2018)
• Damage to communication systems and medical record losses substantially disrupt oncology care.  (Man, 2018)
• Disruptions to cancer care can lead to a decrease in cancer screening, resulting in more patients presenting with advanced disease and an estimated increase in 10,000 excess deaths from breast or colorectal cancer (Sharpless, 2020)

Climate change will lead to an increasing number of pandemics which are associated with an ​increase in rate of infection, complications, and deaths in cancer patients Yu, 2020 

Underserved populations
Impact of climate change on cancer risk is disproportionally worse on underserved  populations   (Ashing, 2022) (Tessum, 2021)(Shultz, 2020) 

As oncology health professionals  and advocates from  23 different countries, we urge lawmakers and policy makers to take action to reduce carbon emissions and environmental degradation that affect the health and treatment of cancer patients.

Signed,
Oncology Health Professionals and Advocates

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