Studies have shown that not only does exposure to wildfire smoke, which contains fine particulate matter, increase the risk of developing lung cancer, it can also significantly reduce survival rates among patients recovering from lung cancer surgery.

A large national study by researchers at the American Cancer Society and Harvard T.H. Chan School of Public Health investigating the health and safety threats wildfires pose to patients recovering from lung cancer surgery has found that these patients experienced longer hospital stays postoperatively than did similar patients treated at the same facility during times when no disaster occurred. The study’s findings emphasize the importance of developing specific disaster preparedness and response guidelines for vulnerable patient populations. The study by Nogueira et al was published in the Journal of the National Cancer Institute.

Study Methodology

The researchers analyzed data from 1,070 patients, selected from the National Cancer Database, who received curative-intent lobectomy or pneumonectomy for stage I to III non–small cell lung cancer (NSCLC) between 2004 and 2021. The mean age of the patients was 69.3 years, most of whom were female (52.7%), non-Hispanic White (77.8%), and diagnosed with stage I disease (62.8%).

Exposure was defined as a Federal Emergency Management Agency wildfire Presidential Disaster Declaration in the county of the treating facility between the date of surgery and the date of discharge from the hospital. Differences in the cumulative distribution function of length of stay were evaluated 1:1 between exposed and propensity score–matched unexposed patients treated at the same facility but during a time when no disasters were declared.

Key Results

The researchers found that patients who were exposed to a wildfire disaster declaration in the county of the treating facility had a nearly 2-day longer length of stay than unexposed patients (9.4 days vs 7.5 days; P < .001). Additionally, the length of stay was longer among exposed patients who had surgery for all stages for which surgery is the recommended treatment modality for NSCLC.

According to the researchers’ findings, unnecessary days in the hospital may have important economic implications for both patients and health-care systems. A shorter length of stay is an established quality metric tied to payment models, and hospital stays cost approximately $1,500 per day. Extended hospital stays also have implications for clinical decision-making for postoperative patients with lung cancer, the use of length of stay as a quality metric, the development of guidelines for protecting people with specific medical conditions that increase susceptibility to climate hazards during disasters, and the development of hospital disaster risk management plans, said the study authors.

Clinical Significance

“These data are critical, as there are currently no guidelines for protecting the health and safety of patients recovering from lung cancer surgery during wildfires in the United States,” said Leticia Nogueira, PhD, MPH, Scientific Director of Health Services Research at the American Cancer Society and lead author of this study, in a statement. “In the absence of guidelines, clinicians might resort to improvisational strategies, such as extending postoperative length of stay to support surgical recovery and better protect the health and safety of patients during wildfires.… Future studies should evaluate whether extended hospital stay improves surgical care outcomes during disasters. Also, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient populations and contextual adjustments to quality care metrics.”

Dr. Nogueira is the corresponding author of this study.

Disclosure: The study authors reported no conflicts of interest.