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When Disaster Strikes: A Scoping Review of Climate-Resilience Toolkits Relevant to Cancer Care Delivery

Konrad Malik,1 Kamryn Thomas,2 Caroline Walsh, MD,3 Andrew Hantel, MD, MPH,4 Caleb Dresser, MD, MPH,5 Katie E. Lichter, MD, MPH2

1Chicago Medical School at Rosalind Franklin University of Medicine and Science, Illinois/USA; 2Geisel School of Medicine at Dartmouth, New Hampshire/ USA; 3University of California, Los Angeles Department of Radiology, California/USA;

4Dana-Farber Cancer Institute, MA/USA; 5Harvard TH School of Public Health, Massachusetts/USA

BACKGROUND

METHODS

  • Extreme weather and system‑level crises increasingly disrupt cancer care1
  • Oncology’s frequent, time‑sensitive treatments heighten vulnerability to interruptions
  • Existing resilience toolkits may not address oncology’s operational realities2
  • Structured scoping review of peer‑reviewed and grey literature (Oct–Dec 2025)
  • Included actionable resources; excluded conceptual‑only resources

CONCLUSIONS

RESULTS

  • Ten resources met criteria; five were formal toolkits
  • None were oncology‑specific
  • Most focused on emergency preparedness and infrastructure, not on treatment continuity
  • Little guidance on patient access, workforce constraints, or scheduling flexibility
  • Oncology‑specific needs — frequent visits, narrow therapeutic windows, multidisciplinary coordination — were largely absent

REFERENCES

  • Current resilience tools overlook the realities of cancer care delivery (e.g. time-sensitive treatments, coordinated multidisciplinary care, complex supply chain)3
  • This gap could lead to treatment delays and inequities during climate‑related disruptions
  • Oncology‑focused, implementation‑ready resilience frameworks are urgently needed to protect continuity and access in vulnerable populations such as cancer patients
  1. Raffetti E, Ahrne M, Döring S, et al. Sustainable transformations for healthcare systems in a changing climate. Cell Rep Sustain. 2024;1(3). doi:10.1016/j.crsus.2024.100054
  2. Gkouliaveras V, Kalogiannidis S, Kalfas D, Kontsas S. Effects of Climate Change on Health and Health Systems: A Systematic Review of Preparedness, Resilience, and Challenges. Int J Environ Res Public Health. 2025;22(2):232. doi:10.3390/ijerph22020232
  3. Lynch, E., Bernicker, E., & Lichter, K. E. (2024). Why we should, and how we can, reduce the climate toxicity of cancer care. JCO Oncology Practice. Advance online publication. https://doi.org/10.1200/OP.24.00680

Figure 1. Methodological Workflow: From Landscape Search to Targeted Characterization

Table 1. Results: Landscape Analysis & Clinical Specificity Gaps

Figure 2. Distribution of Toolkit Focus: Clinical, Geographic, and Operational Domains (N=10)

RESULTS

Key Findings: The Resilience Gap

  • 80% Emergency preparedness: Guidance emphasizes immediate response to disasters over long-term resilience.
  • 10% Rural setting-focused: Absence of frameworks for non-urban providers and healthcare systems to manage remote populations.
  • 0% Clinical Specificity: No specialized protocols were provided for maintaining continuity of treatment in high-acuity cases.

Objective:

  • To identify and characterize existing healthcare resilience toolkits and assess their relevance to oncology care delivery

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