Impact of Declared Wildfire Disasters on Survival of Lung Cancer Patients Undergoing Radiation

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Lichter, Bria Larson, Meghana Pagadala, Osama Mohamad, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5355933/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2025 Read the published version in Cancer Causes & Control → Version 1 posted 7 You are reading this latest preprint version Abstract Purpose Oncological treatments, such as radiotherapy, which requires consistent electricity, the presence of specialized clinical teams, and daily patient access to treatment facilities, are frequently disrupted by extreme weather events, posing several health hazards to patients [ 1 – 3 ]. This study explores the association between declared wildfire disasters during radiotherapy and overall survival among patients with non-small cell lung cancer (NSCLC). Methods The study population consisted of 202,935 adults with inoperable Stage III NSCLC, who initiated radiotherapy from 2004 through 2019. Exposure was defined as a wildfire disaster declaration in the county of the treatment facility within 12 weeks of initiating radiotherapy. Overall survival was defined as the interval (months) between age at diagnosis and age at death, date of last contact, or study end. Cox proportional hazards was used to estimate crude and adjusted hazard ratios and 95% confidence intervals with inverse probability weighting. Results Patients exposed to a wildfire disaster declaration during radiation treatment had worse overall survival (HR, 1.03; 95% CI, 1.00-1.06; p = 0.02), compared to unexposed patients in adjusted models. Conclusion Exposure to a wildfire disaster during radiotherapy is associated with worse overall survival among patients with stage III non-operable NSCLC. This finding underscores the critical need for developing adaptation strategies within the healthcare sector, especially in oncology. Background Oncological treatments such as radiotherapy, which requires consistent electricity, patient access to the treating facility, and the presence of specialized teams to deliver treatment daily, are frequently disrupted by climate-driven extreme weather events [ 1 – 3 ]. This study builds upon prior research (Nogueira et al, 2019) which found an association between exposure to a hurricane disaster during radiotherapy with worse survival among patients with NSCLC and explores the association between declared wildfire disasters during radiotherapy and overall survival among patients diagnosed with inoperable locally advanced non-small cell lung cancer (NSCLC). Methods Individuals aged 18 years and older diagnosed with Stage III NSCLC, who did not receive surgical treatment and initiated definitive radiotherapy from 2004 through 2019 were identified in the National Cancer Database (NCDB), a hospital-based cancer registry co-sponsored by the American College of Surgeons and the American Cancer Society [ 4 ]. Exposure was defined as a Federal Emergency Management Agency (FEMA) wildfire disaster declaration in the county of the treatment facility within 12 weeks of initiating radiotherapy. Time-varying inverse probability weights were generated using logistic regression including geographic region, age, sex, chemotherapy initiation, and month of follow-up to correct for immortal time bias because exposed patients had guaranteed survival between date when radiotherapy started and date of exposure [ 5 ]. Patients exposed to other non-wildfire disasters were censored at the date when the disaster was declared. Overall survival was defined as the interval (months) between age at diagnosis and age at death, last known contact, or study end (December 31, 2019), whichever occurred first. A Cox proportional hazards model was used to estimate crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) with inverse probability weighting. Adjusted models included sex, geographic region, health insurance type, comorbidities, lymph node involvement, type of facility, and concomitant chemotherapy. The institutional review board of the Morehouse School of Medicine granted an exemption for this study in accordance with 45 CFR § 46.102(f). Results Of a total of 202,935 individuals included in the study, 1,513 (0.75%) were exposed to a wildfire disaster within 12 weeks of radiation treatment start date. The median follow-up was 14 months. In the exposed group, the total number of deaths was 1,248 and mean survival time was 24.8 months. In the unexposed group, the total number of deaths was 162,366 and mean survival time was 23.8 months. Patients exposed to a wildfire disaster declaration during radiation treatment had worse overall survival (HR, 1.03; 95% CI, 1.00-1.06; p = 0.02) than unexposed patients in adjusted models. Discussion Exposure to a wildfire disaster during radiotherapy is associated with worse overall survival among patients diagnosed with stage III non-operable NSCLC. Strengths of the study include a large national sample with detailed clinical and demographic information. Limitations include lack of information on date and reason for treatment breaks, disaster-related issues (eg, displacement, worsening mental health, financial hardship), and patient prognostic factors (smoking history, performance status). The findings underscore the critical need for developing adaptation strategies within the healthcare sector, especially in oncology, to mitigate the adverse effects of climate-driven disasters on vulnerable patient populations [ 6 ]. Table 1 Demographic and Clinical Characteristics of Patients with Stage III Non-Operable NSCLC Undergoing Radiotherapy 2004–2019 Overall Exposed Unexposed n 202935 1513 201422 Age at radiotherapy start date, mean (SD) 67.9 (10.3) 68.5 (10.7) 67.8 (10.3) Sex, N (%) Male 110724 (54.6) 790 (52.2) 109934 (54.6) Female 92171 (45.4) 722 (47.8) 91449 (45.4) Race/Ethnicity, N (%) Non-Hispanic White 167868 (83.2) 1165 (77.2) 166703 (83.2) Hispanic 4502 (2.2) 120 (7.9) 4382 (2.2) Non-Hispanic Black 24996 (12.4) 111 (7.4) 24885 (12.4) Asian & Pacific Islander 3275 (1.6) 102 (6.8) 3173 (1.6) Other 1137 (0.6) 12 (0.8) 1125 (0.6) Facility Geographic Region, N (%) Northeast 40705 (20.1) 13 (0.9) 40692 (20.2) Midwest 62268 (30.7) 0 (0.0) 62268 (30.7) South 77341 (38.1) 390 (25.8) 76951 (38.2) West 22621 (11.1) 1110 (73.4) 21511 (10.7) Concomitant chemotherapy, N (%) No 152445 (75.1) 1123 (74.2) 151322 (75.1) Yes 50490 (24.9) 390 (25.8) 50100 (24.9) Lymph node involvement, N (%) No 159083 (78.4) 1188 (78.5) 151322 (78.4) Yes 43852 (21.6) 325 (21.5) 43527 (21.6) Comorbidity, N (%) 0 123517 (60.9) 1046 (69.1) 122471 (60.8) 1 51038 (25.1) 317 (21.0) 50721 (25.2) 2 or more 28380 (14.0) 150 (9.9) 28230 (14.0) Facility type (%) National Cancer Institute - designated 18327 (9.0) 169 (11.2) 18158 (9.0) Comprehensive 78335 (38.6) 582 (38.5) 77753 (38.6) Teaching 37167 (18.3) 179 (11.8) 36988 (18.4) Other 69106 (34.1) 583 (38.5) 68523 (34.0) Median income quintile, $ (%) = 69,000 36292 (17.5) 372 (25.0) 34920 (17.4) Data Sources: Demographic data from the National Cancer Data Base (NCDB). Exposure data from Federal Emergency Management Agency (FEMA). Other includes all Indigenous Populations on the Western hemisphere and the option “other”, which was provided to patients during data collection. Table 2 Mortality Risk for Patients Exposed to a Wildfire while receiving Radiotherapy for Stage III Non-Operable NSCLC, National Cancer Database (2004–2019) Crude and Adjusted Estimates of Hazard Ratio HR 95% CI p-value Crude 0.98 (0.96–1.03) 0.08 Adjusted 1.03 (1.00–1.06) 0.02 Declarations Competing Interests The authors have no relevant financial or non-financial interests to disclose. Ethics Approval The institutional review board of the Morehouse School of Medicine granted an exemption for this study in accordance with 45 CFR § 46.102(f). Consent to participate The study used de-identified data and therefore was deemed exempt from informed consent. Funding Grant funding was received from the Radiation Oncology Institute. Author Contribution K.L. jointly conceived the study with L.N. and O.M, edited the manuscript and supervised the analysis and submission; B.L. conducted the analysis under the supervision of L.N. and K.L. and prepared the manuscript; M.P. edited the manuscript; O.M. conceived of study jointly with L.N. and K.L.; L.N., directed study design, supervised the analysis and edited the manuscript. Acknowledgement The authors would like to thank the individuals and institutions whose support and contributions have facilitated this project. We thank tumor registrars for all their hard work with data collection, which makes studies such as this one possible. We also thank the Radiation Oncology Institute who awarded us grant funding for the project. Data Availability Federal Emergency Management Agency (FEMA) data on presidential disaster declarations is publicly available at: https://www.fema.gov/openfema-data-page/disaster-declarations-summaries-v2National Cancer Database (NCDB) data is available to researchers affiliated with Commission on Cancer accredited facilities in compliance with the Data Use Agreement: https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/puf/ References McMillan MT et al (2017) Radiation Treatment Time and Overall Survival in Locally Advanced Non-small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 98:1142–1152. https://doi.org/10.1016/j.ijrobp.2017.04.004 Nogueira LM, Sahar L, Efstathiou JA, Jemal A, Yabroff KR (2019) Association Between Declared Hurricane Disasters and Survival of Patients With Lung Cancer Undergoing Radiation Treatment. JAMA 322:269–271. https://doi.org/10.1001/jama.2019.7657 Nogueira LM, Yabroff KR, Bernstein A (2020) Climate change and cancer. CA Cancer J Clin 70:239–244. https://doi.org/10.3322/caac.21610 Mallin K et al (2019) Incident Cases Captured in the National Cancer Database Compared with Those in U.S. Population Based Central Cancer Registries in 2012–2014. Ann Surg Oncol 26:1604–1612. http://doi.org/10.1245/s10434-019-07213-1 Zhang D, Xi Y, Boffa DJ, Liu Y, Nogueira LM (2023) Association of Wildfire Exposure While Recovering From Lung Cancer Surgery With Overall Survival. JAMA Oncol 9:1214–1220. http://doi.org/10.1001/jamaoncol.2023.2144 Espinel Z et al (2023) Protecting vulnerable patient populations from climate hazards: the role of the nation’s cancer centers. J Natl Cancer Inst 115:1252–1261. http://doi.org/10.1093/jnci/djad139 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Jan, 2025 Read the published version in Cancer Causes & Control → Version 1 posted Editorial decision: Revision requested 02 Dec, 2024 Reviews received at journal 01 Dec, 2024 Reviewers agreed at journal 10 Nov, 2024 Reviewers invited by journal 07 Nov, 2024 Editor assigned by journal 05 Nov, 2024 Submission checks completed at journal 05 Nov, 2024 First submitted to journal 29 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5355933","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":377444415,"identity":"573405be-78ec-4096-88bf-0883a9d9da87","order_by":0,"name":"Katie E. 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This study builds upon prior research (Nogueira et al, 2019) which found an association between exposure to a hurricane disaster during radiotherapy with worse survival among patients with NSCLC and explores the association between declared wildfire disasters during radiotherapy and overall survival among patients diagnosed with inoperable locally advanced non-small cell lung cancer (NSCLC).\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eIndividuals aged 18 years and older diagnosed with Stage III NSCLC, who did not receive surgical treatment and initiated definitive radiotherapy from 2004 through 2019 were identified in the National Cancer Database (NCDB), a hospital-based cancer registry co-sponsored by the American College of Surgeons and the American Cancer Society [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Exposure was defined as a Federal Emergency Management Agency (FEMA) wildfire disaster declaration in the county of the treatment facility within 12 weeks of initiating radiotherapy. Time-varying inverse probability weights were generated using logistic regression including geographic region, age, sex, chemotherapy initiation, and month of follow-up to correct for immortal time bias because exposed patients had guaranteed survival between date when radiotherapy started and date of exposure [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Patients exposed to other non-wildfire disasters were censored at the date when the disaster was declared.\u003c/p\u003e\u003cp\u003eOverall survival was defined as the interval (months) between age at diagnosis and age at death, last known contact, or study end (December 31, 2019), whichever occurred first. A Cox proportional hazards model was used to estimate crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) with inverse probability weighting. Adjusted models included sex, geographic region, health insurance type, comorbidities, lymph node involvement, type of facility, and concomitant chemotherapy. The institutional review board of the Morehouse School of Medicine granted an exemption for this study in accordance with 45 CFR §\u0026nbsp;46.102(f).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf a total of 202,935 individuals included in the study, 1,513 (0.75%) were exposed to a wildfire disaster within 12 weeks of radiation treatment start date. The median follow-up was 14 months. In the exposed group, the total number of deaths was 1,248 and mean survival time was 24.8 months. In the unexposed group, the total number of deaths was 162,366 and mean survival time was 23.8 months. Patients exposed to a wildfire disaster declaration during radiation treatment had worse overall survival (HR, 1.03; 95% CI, 1.00-1.06; p\u0026thinsp;=\u0026thinsp;0.02) than unexposed patients in adjusted models.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eExposure to a wildfire disaster during radiotherapy is associated with worse overall survival among patients diagnosed with stage III non-operable NSCLC. Strengths of the study include a large national sample with detailed clinical and demographic information. Limitations include lack of information on date and reason for treatment breaks, disaster-related issues (eg, displacement, worsening mental health, financial hardship), and patient prognostic factors (smoking history, performance status). The findings underscore the critical need for developing adaptation strategies within the healthcare sector, especially in oncology, to mitigate the adverse effects of climate-driven disasters on vulnerable patient populations [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and Clinical Characteristics of Patients with Stage III Non-Operable NSCLC Undergoing Radiotherapy 2004\u0026ndash;2019\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExposed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnexposed\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e201422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge at radiotherapy start date, mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.9 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.5 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.8 (10.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110724 (54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e790 (52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e109934 (54.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92171 (45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e722 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e91449 (45.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace/Ethnicity, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Hispanic White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167868 (83.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1165 (77.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e166703 (83.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4502 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4382 (2.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Hispanic Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24996 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24885 (12.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsian \u0026amp; Pacific Islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3275 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3173 (1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1137 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1125 (0.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility Geographic Region, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNortheast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40705 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40692 (20.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62268 (30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e62268 (30.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77341 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e390 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76951 (38.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22621 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1110 (73.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21511 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcomitant chemotherapy, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152445 (75.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1123 (74.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e151322 (75.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50490 (24.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e390 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50100 (24.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymph node involvement, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159083 (78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1188 (78.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e151322 (78.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43852 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e325 (21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43527 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity, N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123517 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1046 (69.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e122471 (60.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51038 (25.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e317 (21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50721 (25.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28380 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28230 (14.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility type (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNational Cancer Institute - designated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18327 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18158 (9.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComprehensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78335 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e582 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77753 (38.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37167 (18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e179 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36988 (18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69106 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e583 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68523 (34.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian income quintile, \u003cspan\u003e$\u003c/span\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;36,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36016 (17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e191 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35825 (17.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36,000\u0026ndash;43,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43300 (21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e256 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43044 (21.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44,000\u0026ndash;52,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43239 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e307 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e42932 (21.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53,000\u0026ndash;68,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43968 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e364 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43604 (21.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;= 69,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36292 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e372 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34920 (17.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData Sources: Demographic data from the National Cancer Data Base (NCDB). Exposure data from Federal Emergency Management Agency (FEMA).\u003c/p\u003e \u003cp\u003eOther includes all Indigenous Populations on the Western hemisphere and the option \u0026ldquo;other\u0026rdquo;, which was provided to patients during data collection.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMortality Risk for Patients Exposed to a Wildfire while receiving Radiotherapy for Stage III Non-Operable NSCLC, National Cancer Database (2004\u0026ndash;2019)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eCrude and Adjusted Estimates of Hazard Ratio\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.96\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.00\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics Approval\u003c/h2\u003e \u003cp\u003eThe institutional review board of the Morehouse School of Medicine granted an exemption for this study in accordance with 45 CFR \u0026sect;\u0026nbsp;46.102(f).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003eThe study used de-identified data and therefore was deemed exempt from informed consent.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eGrant funding was received from the Radiation Oncology Institute.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eK.L. jointly conceived the study with L.N. and O.M, edited the manuscript and supervised the analysis and submission; B.L. conducted the analysis under the supervision of L.N. and K.L. and prepared the manuscript; M.P. edited the manuscript; O.M. conceived of study jointly with L.N. and K.L.; L.N., directed study design, supervised the analysis and edited the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the individuals and institutions whose support and contributions have facilitated this project. We thank tumor registrars for all their hard work with data collection, which makes studies such as this one possible. We also thank the Radiation Oncology Institute who awarded us grant funding for the project.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eFederal Emergency Management Agency (FEMA) data on presidential disaster declarations is publicly available at: https://www.fema.gov/openfema-data-page/disaster-declarations-summaries-v2National Cancer Database (NCDB) data is available to researchers affiliated with Commission on Cancer accredited facilities in compliance with the Data Use Agreement: https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/puf/\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMcMillan MT et al (2017) Radiation Treatment Time and Overall Survival in Locally Advanced Non-small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 98:1142\u0026ndash;1152. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijrobp.2017.04.004\u003c/span\u003e\u003cspan address=\"10.1016/j.ijrobp.2017.04.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNogueira LM, Sahar L, Efstathiou JA, Jemal A, Yabroff KR (2019) Association Between Declared Hurricane Disasters and Survival of Patients With Lung Cancer Undergoing Radiation Treatment. JAMA 322:269\u0026ndash;271. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2019.7657\u003c/span\u003e\u003cspan address=\"10.1001/jama.2019.7657\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNogueira LM, Yabroff KR, Bernstein A (2020) Climate change and cancer. CA Cancer J Clin 70:239\u0026ndash;244. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3322/caac.21610\u003c/span\u003e\u003cspan address=\"10.3322/caac.21610\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMallin K et al (2019) Incident Cases Captured in the National Cancer Database Compared with Those in U.S. Population Based Central Cancer Registries in 2012\u0026ndash;2014. Ann Surg Oncol 26:1604\u0026ndash;1612. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1245/s10434-019-07213-1\u003c/span\u003e\u003cspan address=\"10.1245/s10434-019-07213-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang D, Xi Y, Boffa DJ, Liu Y, Nogueira LM (2023) Association of Wildfire Exposure While Recovering From Lung Cancer Surgery With Overall Survival. JAMA Oncol 9:1214\u0026ndash;1220. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1001/jamaoncol.2023.2144\u003c/span\u003e\u003cspan address=\"10.1001/jamaoncol.2023.2144\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEspinel Z et al (2023) Protecting vulnerable patient populations from climate hazards: the role of the nation\u0026rsquo;s cancer centers. J Natl Cancer Inst 115:1252\u0026ndash;1261. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1093/jnci/djad139\u003c/span\u003e\u003cspan address=\"10.1093/jnci/djad139\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cancer-causes-and-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caco","sideBox":"Learn more about [Cancer Causes \u0026 Control](https://www.springer.com/journal/10552)","snPcode":"10552","submissionUrl":"https://submission.nature.com/new-submission/10552/3","title":"Cancer Causes \u0026 Control","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5355933/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5355933/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eOncological treatments, such as radiotherapy, which requires consistent electricity, the presence of specialized clinical teams, and daily patient access to treatment facilities, are frequently disrupted by extreme weather events, posing several health hazards to patients [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This study explores the association between declared wildfire disasters during radiotherapy and overall survival among patients with non-small cell lung cancer (NSCLC).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study population consisted of 202,935 adults with inoperable Stage III NSCLC, who initiated radiotherapy from 2004 through 2019. Exposure was defined as a wildfire disaster declaration in the county of the treatment facility within 12 weeks of initiating radiotherapy. Overall survival was defined as the interval (months) between age at diagnosis and age at death, date of last contact, or study end. Cox proportional hazards was used to estimate crude and adjusted hazard ratios and 95% confidence intervals with inverse probability weighting.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePatients exposed to a wildfire disaster declaration during radiation treatment had worse overall survival (HR, 1.03; 95% CI, 1.00-1.06; p\u0026thinsp;=\u0026thinsp;0.02), compared to unexposed patients in adjusted models.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eExposure to a wildfire disaster during radiotherapy is associated with worse overall survival among patients with stage III non-operable NSCLC. This finding underscores the critical need for developing adaptation strategies within the healthcare sector, especially in oncology.\u003c/p\u003e","manuscriptTitle":"Impact of Declared Wildfire Disasters on Survival of Lung Cancer Patients Undergoing Radiation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-19 06:20:04","doi":"10.21203/rs.3.rs-5355933/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-02T18:02:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-01T22:40:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65898435311253836771854858250756843816","date":"2024-11-10T20:40:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-07T22:01:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-05T14:30:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-05T13:26:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cancer Causes \u0026 Control","date":"2024-10-29T16:20:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cancer-causes-and-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caco","sideBox":"Learn more about [Cancer Causes \u0026 Control](https://www.springer.com/journal/10552)","snPcode":"10552","submissionUrl":"https://submission.nature.com/new-submission/10552/3","title":"Cancer Causes \u0026 Control","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"acacd177-5b57-4147-a449-b92b7630b709","owner":[],"postedDate":"November 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:07:09+00:00","versionOfRecord":{"articleIdentity":"rs-5355933","link":"https://doi.org/10.1007/s10552-024-01949-2","journal":{"identity":"cancer-causes-and-control","isVorOnly":false,"title":"Cancer Causes \u0026 Control"},"publishedOn":"2025-01-09 15:57:43","publishedOnDateReadable":"January 9th, 2025"},"versionCreatedAt":"2024-11-19 06:20:04","video":"","vorDoi":"10.1007/s10552-024-01949-2","vorDoiUrl":"https://doi.org/10.1007/s10552-024-01949-2","workflowStages":[]},"version":"v1","identity":"rs-5355933","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5355933","identity":"rs-5355933","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}