The state of the oncologist workforce in America in areas prone to natural disasters.

Abstract

11084 Background: Natural disasters are increasingly common in the U.S., causing significant localized disruptions to cancer care. The American Society of Clinical Oncology (ASCO) examines the supply of and demand for cancer services in areas prone to natural disasters to support emergency preparedness planning, response, and recovery. Methods: We tabulated the number of U.S. hematologists and medical oncologists by county from Medicare Care Compare (March 2024 data). Demand for cancer services was approximated using 2017-2021 average annual counts of new cancer cases by county from State Cancer Profiles. We extracted US Climate Vulnerability Index county rankings for extreme flooding, storm, and wildfire events, as well as for community resilience (derived from health, social, economic, infrastructure, and environmental measures). We defined “high-risk” counties as those with the highest decile rankings for extreme flooding, storm, and/or wildfire events across all U.S. counties and determined the share of U.S. oncologists and people with incident cancer in those areas. We also identified oncologists and patient populations in counties adjacent to high-risk counties who might be affected. Among high-risk and adjacent counties, we further isolated those ranked in the highest quartile for baseline vulnerability (i.e., low community resiliency). Results: Of 1.7M people with newly diagnosed cancer in the U.S., a majority (65%, 1.1M) lived in proximity to counties at high-risk for extreme flooding, storms, and wildfires (642K people from 886 counties designated high-risk and 479K from 716 adjacent counties). Similarly, most oncologists (65%, 9,471 of 14,547) practiced in proximity to high-risk counties (5,501 oncologists in top ranked counties, 3,970 in adjacent counties). When factoring in community resilience, 325 counties at or adjacent to high-risk for extreme weather events also ranked highest for baseline vulnerability: 14% of oncologists (n=2,036) worked in these counties, where 13% of people with incident cancer lived (226K). Conclusions: ASCO has recommended that health systems create geographically appropriate plans for natural disasters. Our analysis indicates that most oncologists and most patients in the U.S. are in or adjacent to areas prone to natural disasters, and that many people at risk reside in counties with low community resilience. Practice-level emergency preparedness for response and recovery from natural disasters, including patient referrals and minimization of treatment disruptions, informed by community-specific needs, should be pursued on a broad scale. Additional planning is needed at all levels of the health care system and government to meet this substantial and potentially growing need for crises planning in cancer care. Future research could focus on other types of disasters and on global impacts.