Managing Oncology Care Amidst Rising Wildfire Smoke and Poor Air Quality

As Canadian wildfire smoke blanketed the tri-state area this week, sending the Air Quality Index (AQI) in Midtown Manhattan, for example, into the "unhealthy" range above 150, oncology nursing teams found themselves on the front lines of an escalating environmental health crisis, with fine particulate matter (PM 2.5) reaching hazardous levels in some regions.

Linda Casey, MHA, BSN, RN, OCN, NE-BC, Director of Nursing Operations at the John Theurer Cancer Center (JTCC), Hackensack University Medical Center (HUMC) Infusion/Allergy Centers, emphasized in an interview with Oncology Nursing News that these events require a shift in nursing vigilance.

"We would be most concerned about our lung cancer patients and really any of our patients who have lung involvement, even if that's not the primary disease," Casey said. She also noted that patients with co-morbidities like asthma are at extreme risk during these periods.

The clinical danger of PM 2.5

The danger lies in the composition of wildfire smoke, which is significantly more toxic than standard air pollution. Research indicates that these fine particles can penetrate deep into the lungs and enter the bloodstream, triggering systemic inflammation and potentially speeding up the formation of blood clots. For cancer survivors, the stakes are even higher; recent studies of over seven million patients show that higher PM 2.5 exposure is linked to increased mortality, especially in areas heavily impacted by wildfires.

Nursing teams must be on high alert for specific acute symptoms. Casey advised monitoring for "signs of lung irritation, whether it's coughing, feeling short of breath, etc." These symptoms can be particularly confusing in an oncology setting, where they may compound inflammatory symptoms already related to a patient’s specific medication or treatment regimen.

Operational and environmental adjustments

On days when the sky turns an "ominous brown/yellow," as reported in recent alerts, facilities must act quickly to modify the clinical environment. Casey recommended straightforward but effective operational changes for outpatient units. "We do have some outdoor facilities at our patient cancer center here," Casey explained. "We usually would keep the door locked to the patio so that people aren’t going out there inadvertently being exposed."

Proactive patient education

The transition from reactive care to proactive protocol is essential as climate-driven air quality events become more common. Casey believes air quality education should be standardized alongside existing teachings.

"Just like we have certain drugs that affect people in the cold, we have to include air quality alerts, too," Casey said.

Practical, actionable advice for discharge teaching includes:

• Real-time monitoring: Encouraging patients to use weather monitoring apps to check local AQI levels before leaving the house.
• Effective masking: Advising the use of N95 or KN95 respirators, as standard surgical masks offer minimal protection against fine particulate matter.
• Medical preparedness: Ensuring patients have rescue medications, such as inhalers, with them at all times if they must go outside.
• Indoor safety: Instructing patients to keep windows shut and run air conditioners on recirculation mode to filter indoor air.

A new standard of care

For the millions of cancer survivors in the U.S., clean air is not just a comfort — it is a lifeline. As researchers continue to study the long-term impacts of wildfire smoke on treatment resistance and cancer survival, the role of the oncology nurse as an environmental health advocate is expanding.

By integrating air quality alerts into daily clinical assessments and patient education, nursing teams can mitigate the compounding effects of heat and smoke. As Casey concluded, staying current and knowing one's surroundings is the best defense: "It’s really just monitoring and heightened awareness in those specifically sensitive populations."

References

1. Millman J. Air quality concerns spike as Canadian wildfire smoke thickens over NY, NJ. NBC New York. July 16, 2026.
2. Bebernes M. At least 17 states were under air quality alerts as Canadian wildfire smoke spreads. Yahoo News. July 16, 2026.
3. Huntsman Cancer Institute. Wildfire smoke and cancer health: what you should know. University of Utah Health. June 25, 2026.
4. Moosavi D. Wildfire smoke is changing life after cancer. Fred Hutch Cancer Center. December 23, 2025.