Clinical impacts of the 2025 Southern California wildfires among childhood cancer patients and survivors: A pilot study.

Abstract

e13515 Background: Climate change-related natural hazards threaten healthcare delivery, and wildfires are one such hazard. Wildfires may impede childhood cancer patients and survivors (survivors) from accessing specialized cancer care. Survivors may also be highly sensitive to wildfire smoke due to their young age and medical vulnerability. The 2025 Southern California wildfires, 14 fires that burned 57,000 acres in 1/2025, were an opportunity to evaluate how a major wildfire affected cancer care access and health symptoms among childhood cancer survivors. Methods: Healthcare providers at Children’s Hospital Los Angeles (CHLA) recruited caregivers (e.g. parents, grandparents) of children with a cancer history (on or off therapy) for a 1:1 interview from 11/2025-1/2026. Eligibility included: 1) have a child age < 18 years with a cancer history (on or off therapy), 2) resided in Los Angeles County during 1/2025. Interviews asked about cancer care and general healthcare access, smoke exposure, and respiratory symptoms during 1/2025 as well as evacuation, information seeking, and current impacts on health and finances. We identified common themes and concerns. Results: Eleven interviews were completed. All caregivers expressed high distress about their child’s cancer history but moderate-low wildfire-related distress, which was largely in relation to how evacuation or road closures would impact CHLA access as well as cancer recurrence. Only three caregivers had appointments at CHLA in 1/25, and they adapted to road closures by adding 1-2 hours of travel time. One intentionally missed cancer care to prevent the child’s emotional distress related to wildfire damage. All caregivers noted visible smoke, ash, and odor; one noted a lingering odor and accompanying respiratory discomfort in their household until 4/2025. All were concerned about the child’s wildfire smoke exposure, but not their own. Caregivers of children with concomitant respiratory conditions expressed their greatest concern and took actions including masking and using air filters. Three caregivers noted respiratory symptoms (e.g. coughing) in their children during 1/2025, but none required urgent care. Three caregivers received evacuation alerts, and the two that evacuated noted the lack of shelters appropriate for medically vulnerable children. Caregivers obtained health information and evacuation information from television, friends, family, and phone-based apps. Conclusions: Wildfires pose challenges to deliver pediatric cancer care due to road closures and evacuation notices, and respiratory symptoms are another concern. Healthcare providers should communicate information about wildfire smoke avoidance to patients. Our findings underscore the need for disaster preparedness and communication strategies that ensure continuity of pediatric cancer care and minimize wildfire smoke exposure.