Wildfire Exposure and Survival Outcomes After Surgery for NSCLC

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Investigators have found that exposure to wildfires within 1 year of surgery may significantly lower the chance of survival in patients with non–small cell lung cancer (NSCLC), according to a recent study published by Zhang et al in JAMA Oncology.


Lung cancer is the second most common cancer type and the leading cause of cancer-related mortality in the United States. Exposure to wildfire smoke—a major contributor to air pollution—has been shown to decrease the chance of lung cancer survival. 

“Surgery for lung cancer is a major operation with serious side effects, and recovery takes months,” underscored senior study author Leticia Nogueira, PhD, Scientific Director of Health Services Research at the American Cancer Society. “During recovery, [patients] struggle with physical (diminished pulmonary and physical function, decreased mobility, and increased fatigue), psychological (stress, anxiety, and depression), and socioeconomic (out-of-pocket costs and ability to remain employed or maintain income levels) consequences of surgery—which can impact patients’ ability to prepare and respond to the threats posed by an approaching wildfire,” she stressed.

“In addition to the health consequences of inhaling [wild]fire smoke, the interruption of care, anxiety [caused by] property loss or financial hardship, as well as the mental trauma associated with experiencing a [wild]fire event can work together to negatively affect [patients’] health and well-being,” explained co–study author Yang Liu, PhD, the Gangarosa Distinguished Professor and Chair of the Gangarosa Department of Environmental Health at the Rollins School of Public Health at Emory University. “The impact of smaller fires in the Eastern [United States] also shouldn’t be ignored, as they are often much closer to [patients],” he highlighted.

Study Methods and Results

In this study, the investigators used the National Cancer Database to examine the outcomes of 499,912 patients who underwent surgical resection of NSCLC tumors between 2004 and 2019.

Among the patients involved in the study, 36% (n = 168,645) were exposed to wildfires within 1 year of discharge from the hospital. These patients tended to have worse overall survival rates than the patients who hadn’t been exposed to wildfires. Additionally, the investigators discovered the patients’ chances of survival decreased the sooner they were exposed to wildfires after surgery. For instance, patients whose zip codes overlapped with a wildfire event within 3 months, 4 to 6 months, and 7 to 12 months of NSCLC surgery were 48%, 38%, and 17%, respectively, less likely to survive compared with patients not exposed to a wildfire event.

However, air pollution may be only one of several health threats—such as water and soil contamination, increased stress and mental health issues, forced displacement, and disruption to health-care access—posed by wildfires that can negatively impact the long-term survival of patients recovering from lung cancer surgery. “While wildfire smoke contributes to worsening air quality, which has been associated with increased cancer risk, proximity to wildfires poses several challenges that go beyond inhaling polluted air,” noted Dr. Nogueira. “These … additional challenges are especially concerning for patients [with cancer] and [cancer] survivors, who are already dealing with the physical, psychological, and socioeconomic consequences of cancer diagnoses and treatments,” she added.


“This study shows that the health impact of climate change–related extreme weather events such as wildfires is multifaceted and further-reaching than we typically think,” emphasized Dr. Liu. The researchers warned that the health risks associated with wildfires will likely only intensify in the era of climate change.

“Climate change will result in reduced rainfall, higher temperatures, and drier soil in much of western North America—further exacerbating wildfire activity in the region,” Dr. Liu hypothesized. “We will see a longer [wild]fire season and more frequent, more intense [wild]fires,” he concluded.

Disclosure: The research in this study was funded by the National Aeronautics and Space Administration. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.