Extreme Heat: A New Health Stressor Impacting Cancer Care and Outcomes

In the warming climate of South Florida, oncology researchers are identifying a critical link between seasonal temperatures and the successful delivery of cancer care. New research published in Environmental Research: Climate highlights how environmental stressors act as a significant barrier to treatment adherence and patient well-being.

According to Kilan C. Ashad-Bishop, PhD, a researcher at the Sylvester Comprehensive Cancer Center, the medical community must pivot from treating heat as a temporary weather event to managing it as a chronic clinical factor.

Moving beyond acute heat events

While emergency protocols often focus on acute heatwaves, Ashad-Bishop emphasized in an interview with Oncology Nursing News that the long-term nature of seasonal heat requires a different approach for those with chronic illnesses.

“When heat is acute, when heat is an experience like a heat wave or an extreme weather event, then you can bolster yourself for one day ... but what people spoke to [in the study] is that when heat is seasonal, there are lifestyle shifts that need to happen, and that should be supported,” she said.

For oncology nurses, this means recognizing that patients may be making permanent changes to their routines — such as when they travel or how they manage their homes — that can indirectly impact their care.

Hydration and treatment delays

One of the most immediate clinical risks identified in the study is the relationship between heat and chemotherapy. Ashad-Bishop points out that hydration is a primary concern that can dictate the timeline of a patient’s recovery.

“When it comes to chemotherapeutic treatment, hydration is really important,” she said. “Dehydration can be a reason to delay cancer treatments a lot of times.”

The study suggests that clinical conversations regarding fluid intake must be proactive and specific, regardless of a patient’s living situation. Ashad-Bishop advocated for “speaking with folks about the importance of hydration, even when they're staying inside, even when they're staying in air-conditioned housing units for most of their time.” This is particularly vital in regions where high temperatures and humidity are normalized, as patients may not notice the gradual onset of dehydration until they face medical consequences.

Redefining financial and social support

The research also sheds light on the intersection of "energy insecurity" and the financial toxicity of cancer. Current support programs for utility bills often rely on strict income brackets, which Ashad-Bishop argued are insufficient for cancer-affected households. She notes that standard qualifiers “often do not account for lowered household income as a result of decreased disposable income.”

Because the costs of cancer treatment are so high, a patient’s "on-paper" income rarely reflects their actual ability to pay for the increased electricity needed to stay cool.

“What happens with cancer is that many patients find themselves in a position where no matter how much money they make on paper, their financial resources are being tapped,” she explained.

A call for advocacy

As heat becomes a more constant presence globally, the study encourages health systems to adopt "shared value systems" that address the social determinants of health impacted by climate. This includes practical interventions such as “conversations and advocacy around reducing shut-offs by utility companies among people who are managing chronic disease.”

Ultimately, Ashad-Bishop suggested that the oncology community should be “thoughtful about expanding our support programs and thinking beyond income as a qualifier for the programs that we offer.” By integrating environmental risks into standard care, providers can better support patients navigating the complex overlap of chronic disease and a changing environment.