Importance:In the current era of climate change, extreme heat exposure poses escalating threats to maternal-fetal health. Despite the expansive scale of extreme heat exposure worldwide, dramatized by the record-breaking global ocean and atmospheric temperatures throughout 2023 and into 2024, the extent of the threat posed by heat is underestimated and underappreciated. Unlike the physical destruction wrought by climate-driven events like hurricanes and wildfires, heat exposure does not cause severe damage to the built environment. Yet, in most years, heat has been the deadliest hazard in the United States. Objectives:This expert review aims to illuminate how climate-related heat affects maternal-fetal health and exacerbates health inequities. It will also discuss current knowledge gaps and underscore the crucial role that obstetric providers play in safeguarding pregnant persons from exposure to hazardous heat and increasing patient awareness of climate-related heat. Evidence Acquisition:Evidence for this review was primarily acquired through a comprehensive search of PubMed-indexed articles using MeSH terms and text words to search for concepts related to "climate change," "heat," "obstetrics," "pregnancy," "heat stress disorders," and their synonyms. Results:Extreme heat exposure threatens the health and well-being of pregnant persons and elevates the likelihood of poor birth outcomes like preterm birth, fetal demise, and stillbirth, among other pregnancy complications. Extreme heat exposure also increases the risk of dehydration, heat exhaustion, heat stroke, and gestational hypertension for pregnant persons. Conclusions and Relevance:Ultimately, obstetric professionals are essential to improving the care of pregnant persons at increased risk from salient climate-related heat exposure.

Objective: A parallel randomized clinical trial evaluated the efficacy of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) for victims of terrorist attacks with long-term psychopathology. Method: 120 adult Spanish victims, who met the criteria for current posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and/or anxiety disorders related to exposure to terrorist attacks that occurred 18 years ago, on average, were randomly assigned to 16 weekly sessions of TF-CBT (n = 60) or waiting list control conditions (n = 60). Results: Participants who completed TF-CBT (n = 25) experienced significant pre-post decreases in diagnostic rates and in posttraumatic stress, depression, and anxiety symptoms. Pre/post effect sizes for the TF-CBT-treated participants were large (gPCL-S = 1.25; gBDI-II = 1.03; gBAI = 1.16), and between-groups effect sizes were medium-large (gPCL-S =  0.94, gBDI-II = 0.72, gBAI = 0.95). Most TF-CBT completers (78.3% to 91.7%) achieved sub-syndromal symptom levels by post-treatment. The benefits persisted to the 6-month follow-up (n = 22). Modified intention-to-treat analyses (n = 35 vs. n = 50) confirmed the significance of the findings for PTSD and were significant but less robust for MDD and anxiety disorders. Conclusion: TF-CBT appears to be efficacious when applied to victims of terrorism with long-term psychopathology.Clinical or methodological significance of this articleTF-CBT was efficacious when applied to victims of terrorism with long-term PTSD. Results were significant but less robust for long-term MDD and anxiety disorders.

BACKGROUND:Wildfires pose substantial health and safety threats to patients recovering from lung cancer surgery. Without specific disaster preparedness guidelines, surgical oncologists might resort to improvisational strategies, such as extending post-operative length of stay (LOS) to support surgical recovery and better protect the health and safety of patients. METHODS:Individuals aged ≥18 years who received curative-intent lobectomy or pneumonectomy for stage I-III non-small-cell lung cancer between 2004 and 2021 were selected from the National Cancer Database. 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 LOS were evaluated between exposed and propensity score-matched unexposed patients treated at the same facility. RESULTS:Patients exposed to a wildfire disaster declaration in the county of the treating facility had longer LOS than unexposed patients (9.4 days compared to 7.5 days, respectively; P < .001) overall and for each stage (I-III) for which surgery is the recommended treatment modality. CONCLUSIONS:Patients whose facility was impacted by a wildfire disaster during recovery from lung cancer surgery had longer LOS than similar patients treated at the same facility but at times when no disaster occurred. Such findings complicate the use of LOS as a post-operative quality metric. Future studies should evaluate whether extended hospital stay improves surgical care outcomes during disasters. Moreover, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient populations.

This comment explores the pivotal role of qualitative research for expanding knowledge and practice—and filling in gaps—around protecting patients with cancer from compounding disasters. Climate-related hazards are creating accelerating threats to population health, particularly in the realm of exposures to perilous heat and extreme weather events. Patients with cancer, including those recently diagnosed, currently undergoing treatment, or in survivorship, experience elevated risks due to their compromised health status and vulnerability to cancer care disruptions during disasters. Patients with cancer require customized support for performing both general and cancer care-specific disaster preparedness actions. A multi-disciplinary team of oncologists, psycho-oncologists, cancer researchers, and disaster public health and mental health experts is collaborating on mixed-methods research to define the best approaches for supporting patients with cancer to optimize their health and safety during exposures to hazards such as extreme heat and weather-related disasters. This comment outlines the use of qualitative approaches, including focus groups with patients and patient advisory committee members, subject matter expert interviews, and key informant interviews with cancer center professionals as a complement to detailed quantitative surveys to explicate disaster preparedness strategies and devise a “toolkit” of practical disaster preparedness resources matched to the unique needs of patients with cancer. Qualitative research is optimally suited for developing a nuanced understanding of how patients with cancer receive disaster warnings, make preparedness decisions, engage in protective actions, use social support, and deal with the combined stressors of their cancer diagnosis and disaster threat. Qualitative research provides critical insights into the creation and evaluation of tools to enhance disaster preparedness across all stages of the cancer journey, from initial diagnosis through treatment and into survivorship.

This Viewpoint discusses how oncologists can support environmental strategies to reduce dependence on petrochemicals, which are associated with cancer risk.

5wPatients with end stage kidney disease (ESKD) who receive in-center hemodialysis are disproportionately vulnerable to extreme weather events, including hurricanes and heat waves, that may disrupt access to healthcare providers, and life-sustaining treatments. This current era of climate-driven compounding disasters is progressively elevating the level of threat to the health and well-being of patients with ESKD. This analysis brings together multi-disciplinary expertise to explore the contours of this increasingly complex risk landscape. Despite the challenges, important advances have been made for safeguarding this medically high-risk patient population. Hemodialysis services providers have devised innovative systems for preparing their patients and sustaining, or rapidly reestablishing, hemodialysis services in the aftermath of a disaster, and maintaining open lines of communication with their caseloads of ESKD patients throughout all phases of the event. A description of lessons learned along the path towards improved patient support in disasters, is provided. The article concludes with a detailed case example, describing dialysis providers' effective response throughout Hurricane Ian's passage across the State of Florida in 2022. Based on lessons learned, this analysis outlines strategies for protecting patients with ESKD that may be adapted for future climate-potentiated disaster scenarios.

Abstract This chapter evaluates interpersonal counseling (IPC) for internally displaced women in Bogotá, Colombia. No other nation throughout the Americas has experienced internal displacement on a scale comparable to Colombia. Colombian internally displaced persons (IDPs) have a high prevalence of trauma exposure and correspondingly high rates of common mental disorders (CMDs), especially among women. The chapter then looks at a feasibility and acceptability pilot study to examine the potential efficacy of an evidence-based, stepped-care intervention adapted for depression, anxiety, and post-traumatic stress disorder (PTSD) for IDP women residing in Bogotá. The study was named OSITA (meaning “little teddy bear” in Spanish), an acronym for Outreach, Screening, and Intervention for TraumA. Feedback from IPC trainees and participants confirmed that the 4 therapeutic foci of IPC were highly relevant to the target population. Analyses of symptom changes in the sample of completers with baseline, last session, and follow-up data points revealed significant decreases over time in depression, anxiety, and PTSD symptom levels from baseline to last IPC session and further significant decreases in depression from last IPC session to follow-up.

311 Background: Wildfires pose substantial health and safety threats to patients recovering from lung cancer surgery. Without specific disaster preparedness guidelines, oncologists might resort to improvisational strategies, such as increasing the length of stay (LOS), a federal care quality measure with financial implication for hospitals, to better protect the health and safety of this medically vulnerable population. Methods: Individuals aged ≥18 years who received curative-intent lobectomy or pneumonectomy for stage I-III NSCLC between 2004 and 2021 were selected from the National Cancer Database. Exposure was defined as a Federal Emergency Management Agency (FEMA) Presidential Disaster Declaration in the county of the treatment facility between date of surgery and date of discharge from the hospital. Differences in the cumulative distribution function of LOS, defined as days between date of surgery and date of discharge from the hospital, were evaluated between exposed and propensity score matched unexposed patients, who were treated at the same facility but at a time when no disasters occurred, using the product-limit method and log-rank test. In sensitivity analysis, patients with discharge date equal to date of death (in-hospital mortality) were excluded, and the association was evaluated stratified by stage. Results: Patients exposed to a wildfire disaster declaration in the county of the treating facility had longer LOS (p<0.001) than unexposed patients (9.4days compared to 7.5 days, respectively) overall and for each of the stages (I-III) for which surgery is the recommended treatment modality. In sensitivity analysis, there were no in-hospital mortality difference between exposed and unexposed patients (10.8% and 10.5%, respectively, p=0.76). Excluding patients who died in the hospital did not change the main results. Conclusions: Patients whose facility is impacted by a wildfire disaster during recovery from lung cancer surgery have longer length of stay than similar patients treated at the same facility but at times when no disaster occurred. Future studies should evaluate whether extended hospital stay improves safety and quality of surgical care. Moreover, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient population.

Migrants and refugees face elevated risks for mental health problems but have limited access to services. This study compared two strategies for training and supervising nonspecialists to deliver a scalable psychological intervention, Group Problem Management Plus (gPM+), in northern Colombia. Adult women who reported elevated psychological distress and functional impairment were randomized to receive gPM+ delivered by nonspecialists who received training and supervision by: 1) a psychologist (specialized technical support); or 2) a nonspecialist who had been trained as a trainer/supervisor (nonspecialized technical support). We examined effectiveness and implementation outcomes using a mixed-methods approach. Thirteen nonspecialists were trained as gPM+ facilitators and three were trained-as-trainers. We enrolled 128 women to participate in gPM+ across the two conditions. Intervention attendance was higher in the specialized technical support condition. The nonspecialized technical support condition demonstrated higher fidelity to gPM+ and lower cost of implementation. Other indicators of effectiveness, adoption and implementation were comparable between the two implementation strategies. These results suggest it is feasible to implement mental health interventions, like gPM+, using lower-resource, community-embedded task sharing models, while maintaining safety and fidelity. Further evidence from fully powered trials is needed to make definitive conclusions about the relative cost of these implementation strategies.

Climate-driven disasters have disproportionate and often devastating consequences on individuals with disabilities. Warming ocean and air temperatures are fueling more extreme tropical cyclones, further endangering those living in at-risk regions. Although hurricane preparedness is particularly critical for those with functional impairments and/or special medical needs, studies show such persons are less ready for disasters than the general population. This review calls attention to the time-urgent need to improve hurricane readiness among persons with disabilities. It summarizes evidence that climate change is resulting in cyclonic storms that are increasingly jeopardizing the health and safety of affected persons and reflects on how this trend may compound the particular hardships those with disabilities experience during times of disaster. It identifies unique storm-related challenges faced by patient populations commonly cared for by physiatrists, including those with stroke, traumatic brain injury, multiple sclerosis, spinal cord injury, and limb loss. Available research pertaining to the gaps in emergency preparedness practices among persons with disabilities is reviewed as are potential strategies to mitigate barriers to achieving disaster readiness and resilience. Lastly, the review provides physiatrists with a comprehensive guide for optimally safeguarding their patients before, during, and after catastrophic hurricanes.

Medically high-risk patients (MHRPs)—persons living with health conditions that require readily available, dependable, and sometimes uninterrupted access to health services and supplies—face escalating risks when exposed to disasters.1Espinel Z. Nogueira L.M. Gay H.A. et al.Climate-driven Atlantic hurricanes create complex challenges for cancer care.Lancet Oncol. 2022; 23: 1497-1498https://doi.org/10.1016/S1470-2045(22)00635-0Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar,2Balbus J.M. Malina C. Identifying vulnerable subpopulations for climate change health effects in the United States.J Occup Environ Med. 2009; 51: 33-37https://doi.org/10.1097/JOM.0b013e318193e12eCrossref PubMed Scopus (242) Google Scholar MHRPs include persons with cognitive and functional impairments3Shapiro L.T. Gater Jr., D.R. Espinel Z. Kossin J.P. Galea S. Shultz J.M. Preparing individuals with spinal cord injury for extreme storms in the era of climate change.eClinicalMedicine. 2020; 18100232https://doi.org/10.1016/j.eclinm.2019.12.002Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar; health conditions requiring access to essential services, such as cancer therapies4Nogueira L.M. Yabroff K.R. Bernstein A. Climate change and cancer.CA Cancer J Clin. 2020; 70: 239-244https://doi.org/10.3322/caac.21610Crossref PubMed Scopus (52) Google Scholar or psychiatric treatment; or transient health conditions that temporarily increase vulnerability, such as pregnancy or post-surgical recovery.5Alnajar A. Bud Frazier O.H. Elgalad A. Smith P.A. Shultz J.M. Preparing end-stage heart failure patients and care providers in the era of climate change-driven hurricanes.J Card Surg. 2021; 36: 3491-3493https://doi.org/10.1111/jocs.15784Crossref PubMed Scopus (2) Google Scholar Disasters are events that disrupt societal functioning, causing widespread human, material, or environmental harm while exceeding the coping capacity of the affected communities. With increasing frequency, the overlapping and amplifying impacts of compounding disasters—diverse co-occurring or rapidly-sequential disruptive events, ranging from global (climate change, pandemic diseases) to local—are exacerbating harm and complicating recovery. MHRPs experience disproportionate risks across a broad spectrum of disasters. Throughout 2023, the hottest year on record (Fig. 1), climate change-fuelled extreme weather events (EWEs) featured prominently. Deadly heat domes formed over vast areas of the Americas—in the global North and South—previously assumed to be sheltered from extreme weather. Dense Canadian wildfire smoke reached US population centres unaccustomed to this environmental hazard and ill prepared to respond. Within 19 days, warm Atlantic waters generated nine named tropical storms. Climate-driven drought magnified the severity of wildfires in Chile. Brazil experienced unprecedented precipitation and deadly flooding from an extratropical cyclone. Yet strategies to protect the health of MHRPs from these hazards and harms remain poorly conceived and rarely implemented. MHRPs experience unique vulnerabilities during disasters depending on their medical diagnosis, stage and severity of illness, treatment regimens and side-effects, current health and functional status, and reliance on healthcare and social support systems. In a disaster context, MHRPs frequently experience elevated risks while evacuating and sheltering, increased healthcare needs, aggravation of symptoms, interruption of vital healthcare services, increased susceptibility to injury or disease outbreaks, increased risk of cardiorespiratory events, and elevated stress levels.1Espinel Z. Nogueira L.M. Gay H.A. et al.Climate-driven Atlantic hurricanes create complex challenges for cancer care.Lancet Oncol. 2022; 23: 1497-1498https://doi.org/10.1016/S1470-2045(22)00635-0Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 2Balbus J.M. Malina C. Identifying vulnerable subpopulations for climate change health effects in the United States.J Occup Environ Med. 2009; 51: 33-37https://doi.org/10.1097/JOM.0b013e318193e12eCrossref PubMed Scopus (242) Google Scholar, 3Shapiro L.T. Gater Jr., D.R. Espinel Z. Kossin J.P. Galea S. Shultz J.M. Preparing individuals with spinal cord injury for extreme storms in the era of climate change.eClinicalMedicine. 2020; 18100232https://doi.org/10.1016/j.eclinm.2019.12.002Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 4Nogueira L.M. Yabroff K.R. Bernstein A. Climate change and cancer.CA Cancer J Clin. 2020; 70: 239-244https://doi.org/10.3322/caac.21610Crossref PubMed Scopus (52) Google Scholar, 5Alnajar A. Bud Frazier O.H. Elgalad A. Smith P.A. Shultz J.M. Preparing end-stage heart failure patients and care providers in the era of climate change-driven hurricanes.J Card Surg. 2021; 36: 3491-3493https://doi.org/10.1111/jocs.15784Crossref PubMed Scopus (2) Google Scholar, 6Adams R.M. Eisenman D.P. Glik D. Community advantage and individual self-efficacy promote disaster preparedness: a multilevel model among persons with disabilities.Int J Environ Res Public Health. 2019; 16: 2779https://doi.org/10.3390/ijerph16152779Crossref PubMed Scopus (38) Google Scholar Higher mortality rates were documented following hurricane-related disruptions of radiotherapy treatments for patients with lung cancer7Nogueira L.M. Sahar L. Efstathiou J.A. Jemal A. Yabroff K.R. Association between declared hurricane disasters and survival of patients with lung cancer undergoing radiation treatment.JAMA. 2019; 322: 269-271https://doi.org/10.1001/jama.2019.7657Crossref PubMed Scopus (40) Google Scholar and haemodialysis treatments for patients with end stage kidney disease (ESKD).8Blum M.F. Feng Y. Anderson G.B. Segev D.L. McAdams-DeMarco M. Grams M.E. Hurricanes and mortality among patients receiving dialysis.J Am Soc Nephrol. 2022; 33: 1757-1766https://doi.org/10.1681/ASN.2021111520Crossref PubMed Scopus (4) Google Scholar Because the physical, psychological, and socioeconomic challenges associated with chronic medical and psychiatric conditions make it harder for MHRPs to cope with added stressors when a disaster strikes,9Espinel Z. Shultz J.M. Aubry V.P. et al.Protecting vulnerable patient populations from climate hazards: the role of the nation's cancer centers.J Natl Cancer Inst. 2023; 115: 1252-1261https://doi.org/10.1093/jnci/djad139Crossref PubMed Scopus (1) Google Scholar medical, sociopolitical, and environmental factors need to be considered while developing strategies to safeguard MHRPs from disasters. For example, in addition to well-established emergency preparedness strategies developed to protect the general population, including guidelines for developing a household plan for sheltering in place or evacuating, MHRPs require additional strategies customized for the specific needs and vulnerabilities of their medical conditions and tailored to different hazard scenarios. Importantly, sociopolitical contexts have profound implications for disaster preparedness strategies because structural factors, such as exposure to systemic racism, patriarchy, and ableism, shape the hazard profile and limit access to emergency resources when disaster strikes.10Nogueira L. White K.E. Bell B. et al.The role of behavioral medicine in addressing climate change-related health inequities.Transl Behav Med. 2022; 12: 526-534https://doi.org/10.1093/tbm/ibac005Crossref PubMed Scopus (8) Google Scholar Throughout the Americas, healthcare settings serving individuals facing the greatest barriers to vital resources differ from the healthcare settings serving those who benefit from privilege. To avoid widening disparities, strategies that prioritise equity such as reducing out-of-pocket expenses when developing MHRP-specific disaster preparedness and response strategies; promoting intersectional approaches that address social determinants of health; improving diversity among health and disaster professionals; co-creating knowledge in settings where disenfranchised communities interact with healthcare; and developing contextually relevant strategies, are crucial for protecting the health and safety of all MHRPs and ensuring availability and continuity of care during disasters. Environmental factors and associated risks must also be considered during impact (e.g., infection risks during flooding events, cardiorespiratory risks during wildfires, thermoregulatory risks during extreme temperatures), and in the aftermath (e.g., food and water insecurity, displacement). Prolonged periods without power are especially concerning for MHRPs who rely on electricity-dependent assistive equipment, refrigeration for essential medications, or heating/cooling systems for ambient temperature control. Creating customized disaster preparedness strategies is complicated by climate change, which alters the frequency, predictability, and behaviour of extreme weather events. We recommend a three-pronged approach to develop disaster preparedness and response strategies that protect the health and safety of MHRPs from rapidly evolving environmental hazard scenarios propelled by climate change. First, facilitate information sharing among medical specialties so that best practices for safeguarding one MHRP population can be adapted for others.9Espinel Z. Shultz J.M. Aubry V.P. et al.Protecting vulnerable patient populations from climate hazards: the role of the nation's cancer centers.J Natl Cancer Inst. 2023; 115: 1252-1261https://doi.org/10.1093/jnci/djad139Crossref PubMed Scopus (1) Google Scholar For example, during Hurricane Ian in 2022, haemodialysis services providers used centralised databases to track their patients with ESKD and direct them to nearby dialysis centres that had reopened after the storm to rapidly resume their treatments. Similar protocols could be devised to minimise disaster-triggered disruptions to life-sustaining treatments for other MHRP populations.1Espinel Z. Nogueira L.M. Gay H.A. et al.Climate-driven Atlantic hurricanes create complex challenges for cancer care.Lancet Oncol. 2022; 23: 1497-1498https://doi.org/10.1016/S1470-2045(22)00635-0Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar,2Balbus J.M. Malina C. Identifying vulnerable subpopulations for climate change health effects in the United States.J Occup Environ Med. 2009; 51: 33-37https://doi.org/10.1097/JOM.0b013e318193e12eCrossref PubMed Scopus (242) Google Scholar Second, stimulate multi-disciplinary research to address distinct hazards, specific vulnerabilities, and unique challenges that MHRPs and their health and psychosocial support systems face during compounding disaster scenarios. For example, interventions that address risks for MHRPs exposed to extreme temperatures could integrate climate monitoring, active patient tracking, individualized disaster preparedness communications delivered during patient encounters or using digital messaging technologies, and contextual strategies centering on community expertise and cultural norms. Research is urgently needed to develop strategies to optimize mental health and well-being for MHRPs grappling with the layered psychosocial stressors of surviving and recovering from a disaster while living with a challenging medical condition. Finally, research will facilitate the development of preparedness strategies adapted to the complexities of the compounding risk landscape that leverage technology and infuse local knowledge to circumvent disaster-related care disruptions. Third, equitably prioritise the roles and expertise of persons from communities targeted for marginalisation and professionals from underrepresented backgrounds in every step of the process.10Nogueira L. White K.E. Bell B. et al.The role of behavioral medicine in addressing climate change-related health inequities.Transl Behav Med. 2022; 12: 526-534https://doi.org/10.1093/tbm/ibac005Crossref PubMed Scopus (8) Google Scholar Failure to integrate the wisdom and lived experience of diverse individuals—including MHRPs themselves and their caregivers, support networks, and providers—limits the knowledge and sensitized perspectives available to tackle growing challenges in this era of climate-driven compounding disasters. The expanding constellation of disruptive events unfolding around the globe in this era of compounding disasters provides powerful impetus for healthcare and emergency management professionals to devise strategies to safeguard MHRPs during disasters, an effort that can be accelerated through collaborative partnerships that incorporate diverse expertise and backgrounds. James M. Shultz conceptualized the paper, selected authors, led the writing, and serves as corresponding author. Sandro Galea contributed instrumentally to the review and editing of the manuscript and the recommendations for safeguarding high-risk patients and he encouraged contributions from MHRP representatives. Zelde Espinel provided key input on mental health, psychosocial support, and compounding disasters. Amruta Nori-Sarma contributed to the focus on environmental hazards, particularly extreme heat, review, and editing. Lauren T. Shapiro brought the perspective of a practicing physiatrist who treats a range of medically high-risk patients, particularly those with mobility impairment. Karen Dimentstein contributed the essential perspective of an individual who is a medically high-risk person and added to the review and editing throughout. J. Marshall Shepherd contributed the atmospheric science viewpoint and added to the focus on compounding disasters. Leticia M. Nogueira contributed instrumentally to conceptualization, integration of climate change and health equity issues, review, and editing, and she serves as senior author. None. The authors declared no conflicts of interest. None.

Caribbean small island developing states are becoming increasingly vulnerable to compounding disasters, prominently featuring climate-related hazards and pandemic diseases, which exacerbate existing barriers to cancer control in the region. We describe the complexities of cancer prevention and control efforts throughout the Caribbean small island developing states, including the unique challenges of people diagnosed with cancer in the region. We highlight potential solutions and strategies that concurrently address disaster adaptation and cancer control. Because Caribbean small island developing states are affected first and worst by the hazards of compounding disasters, the innovative solutions developed in the region are relevant for climate mitigation, disaster adaptation, and cancer control efforts globally. In the age of complex and cascading disaster scenarios, developing strategies to mitigate their effect on the cancer control continuum, and protecting the health and safety of people diagnosed with cancer from extreme events become increasingly urgent. The equitable development of such strategies relies on collaborative efforts among professionals whose diverse expertise from complementary fields infuses the local community perspective while focusing on implementing solutions.

e18729 Background: Climate change is altering the frequency and behavior of extreme weather events making it harder for institutions to prepare and respond to increasingly unpredictable circumstances. Emergency preparedness efforts are crucial for meeting the health and safety needs of patients, providers, healthcare facilities, and communities before, during, and after a disaster. National Cancer Institute (NCI)-Designated Cancer Centers are at the forefront of quality cancer care and research, have greater access to resources through accreditation, and are nationally distributed, collectively acquiring a range of emergency preparedness and response experiences on a variety of disasters nationwide. This study evaluated emergency preparedness information provided in NCI-designated Cancer Centers’ websites. Methods: We systematically searched NCI-Designated Cancer Centers’ websites for the presence of information on emergency preparedness and response instructions, resources, and research efforts in September 2022. Results: Out of 71 centers, all (100%) were impacted by a climate-driven disaster between 2016 and 2020, 56 (78.9%) presented some emergency preparedness information, and 36 (50.7%) presented information specific to individuals diagnosed with cancer, all of which included information relevant for the COVID-19 pandemic. In contrast, only 17 (23.9%) of centers’ websites provided emergency preparedness information relevant for climate-driven disasters, and only 7 (9.5%) provided information on emergency preparedness for climate-driven disaster specific for individuals diagnosed with cancer. Just one center (1.4%) mentioned ongoing research on emergency preparedness for cancer patients. None of the centers provided emergency preparedness or response information in a centralized and structured manner. Conclusions: Emergency preparedness research efforts and information sharing on NCI-Designated Cancer Centers’ websites has not kept pace with the challenges posed by climate change. Prioritizing research efforts and structured information sharing of emergency preparedness and response expertise will be crucial to ensure receipt of quality cancer care in the era of compounding disasters.

Individuals diagnosed with cancer are a vulnerable population during disasters. Emergency preparedness efforts are crucial for meeting the health and safety needs of patients, health-care professionals, health-care facilities, and communities before, during, and after a disaster. Recognizing the importance of advancing emergency preparedness expertise to cancer control efforts nationwide, especially in the era of climate change, we searched National Cancer Institute-designated cancer centers' websites to examine emergency preparedness information sharing and evidence of research efforts focused on disaster preparedness. Of 71 centers, 56 (78.9%) presented some emergency preparedness information, and 36 (50.7%) presented information specific to individuals diagnosed with cancer. Only 17 (23.9%) centers provided emergency preparedness information for climate-driven disasters. Informed by these data, this commentary describes an opportunity for cancer centers to lead knowledge advancement on an important aspect of climate change adaptation: disaster preparedness.

Persons diagnosed with end-stage kidney disease (ESKD) who require in-center hemodialysis are among the most vulnerable patients in this era of compounding disasters. Climate change is making Atlantic hurricanes stronger and wetter, with a tendency to stall at the time of landfall, resulting in more powerful and damaging storms that may disrupt dialysis and clinical services for ESKD patients. COVID-19 and airborne disease transmission complicates hurricane evacuation and sheltering. This complex risk landscape requires tailored approaches to disaster preparedness for patients, clinicians, and dialysis providers. We interviewed dialysis providers about their 2022 Hurricane Ian experience. We developed a survey that examines ESKD patients' hurricane threat appraisal, adaptation appraisal, hurricane experience, and disaster preparedness (household preparedness, COVID-19 prevention, ESKD-specific preparedness). Dialysis providers have developed elaborate strategies for warning, preparing, and predialyzing their patients when a hurricane is approaching. They prestage tanker trucks with pure water and with diesel fuel to power the auxiliary generators to provide electricity. Among 232 dialysis centers closed on the day when Hurricane Ian made landfall, 50% were operational 2 days poststorm and 99% were operational 5 days poststorm. Patient preparedness survey results will be presented. Compared with other medically vulnerable patient populations, patients with ESKD are disaster-prepared and supported by their network of dialysis providers to maintain or rapidly restart their life-sustaining treatments. Multilayered, climate-driven disaster risks amplify the urgency for developing effective approaches for safeguarding patients with ESKD, their caregivers, their providers, and their care systems.