Too Much Water. Not Enough Fluid.
Will disruptions in cancer care be the impetus to address climate change?
In September, Hurricane Helene swept through western North Carolina. You probably saw photos of the resulting devastation. It made international news. Many people lost their homes. Some are still waiting for phone service. Most have power back. Downtown Asheville finally has potable water.
Hundreds of miles from the mountains, we were spared. Other than checking on friends and sending donations to organizations trying to help, the impact on my day-to-day life was minimal. Or so I thought.
A week or so after the storm, I heard a local news anchor mention “critical IV fluid shortages.” These messages were common during COVID as overtaxed supply chains fought to keep up, but I hadn’t heard about this. IV Fluids? The broadcast moved on, so I did a quick search on my phone.
How could we be rationing IV fluid? That’s like saying hospitals are out of blood pressure cuffs or Tylenol.
According to the CDC, the national supply of three types of fluid was dangerously low:
lactated Ringer’s solution - used most commonly in surgical procedures
70% dextrose solution - given to patients who need nutritional support
And peritoneal dialysis solution - used by people whose kidneys don’t filter waste
None of these are what I would consider optional treatments.
As I read on, the link between this critical shortage and Hurricane Helene became clear. The 2,500 employees at the Baxter manufacturing plant in North Cove, North Carolina send 1.5 million bags to hospitals across the country. This accounts for 60% of all IV fluid bags used in the United States.
Mud, water and storm damage from Hurricane Helene had rendered the Baxter manufacturing facility unsafe and unusable.
The federal government moved swiftly to address this shortage. The CDC encouraged hospitals to institute mitigation strategies and ration their current supplies.
The FDA temporarily allowed IV fluid bags from production facilities outside the US to be flown in until production at the Baxter plant was able to restart. But these were all temporary measures. How long could this go on?
At work, I began to pay attention to communication about this unfolding crisis. Daily emails outlined the health system’s current supply, identified critical areas of need and encouraged us to think wisely about how we used this limited resource.
Although I worry about climate change at home, I had never thought about it at work. Melting ice caps seemed like something that would impact our farm, not my patients. Hurricane Helene brought the problem right up to my exam room door.
Most of my patients receive chemotherapy of one form or another. That chemotherapy is individually mixed by specialized pharmacists…in bags of IV fluids. As are the premeds that patients are given to prevent them from vomiting.
Many spend hours after chemotherapy hooked up to bags of fluids that flush the toxic chemotherapy through their kidneys.
Every patient is hooked up to a bag of IV fluid during surgical procedures. Some who have difficulty swallowing during treatment receive IV fluids for rehydration.
Although much of this fluid is normal saline which was not impacted by the Baxter plant, the shortage of these other fluids would lead doctors to use what they had: normal saline. That translated into less normal saline on the shelves for patients with cancer. When would that shortage reach us? Would oncologists be forced to decide who got chemo? What would that look like?
In 2023, the American Society of Clinical Oncology (ASCO) outlined the impact of increasing levels of carbon dioxide, rising temperatures, rising sea levels, and increasing frequency, intensity, and duration of extreme weather event on cancer care.
Disrupted Treatment
Extreme weather events disrupt cancer care. Patients have difficulty accessing cancer centers and facilities are not able to provide cancer treatment after major weather events. For example, patients with cancer treated in storm affected areas had lower survival rates than expected.
Increased Risk of Developing Cancer
Air pollution is estimated to cause 14% of lung cancers. And fossil fuel emissions have been associated with other types of cancer.
Impact on Vulnerable Populations
Increased exposure to pollution and limited resources to avoid exposure leave elderly and vulnerable citizens at high risk for toxic exposures. And when a storm hits these areas, the already limited healthcare infrastructure may not fully recover. After Hurricane Katrina, for example, a quarter of physicians never returned to Louisiana and half the inpatient hospital units in New Orleans permanently closed.
Oncology’s Contributions to Climate Change
The healthcare system is responsible for 8.5% of all US carbon emissions. Single use packaging which is prevalent in operating rooms as well as infusion suites is a huge contributor to medical waste.
I thought that our collective motivation to address climate change would be to save the polar bears. Or to ensure a habitable planet for our children.
It turns out, we may have to solve it to save ourselves.
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On my mind…
Scientists in China have developed a foam that filters 95% of microplastics from water. 🙏🙏🙏
Link to the article: https://www.science.org/doi/10.1126/sciadv.adn8662
I noticed the impact when I had surgery on the 19th. They were super short on fluids; I was on the onc floor post op because my doc had many ca pts there. I’m wondering why there’s been such an increase in some types of colon cancers of late? Anyway, my perf is now closed, fistula taken down, and I’m recovering pretty nicely! Your article gives me great pause to our vulnerabilities.