Air pollution is emerging as an overlooked threat to the long-term health of childhood cancer survivors, according to new research from University of California – San Francisco.
The research found that survivors, who are already vulnerable to chronic conditions caused by their disease and its treatment, face significantly worse outcomes when exposed to air pollution caused by oil wells, pesticides and wildfire smoke.
Childhood cancer survivors are living longer than ever, but survival often comes with lasting health complications. By midlife, nearly all survivors experience at least one chronic health condition but these new findings suggest that air pollution compounds these risks, leading to higher hospitalisation rates and lower survival.
In Utah, the researchers found that paediatric cancer survivors living in areas with high levels of PM2.5 faced an 84% greater risk of respiratory hospitalisation. A follow-up study linked cumulative PM2.5 exposure with increased mortality among survivors of leukemia, lymphoma and brain tumours, as much as five to ten years after diagnosis.
Survivors living near oil and gas wells in Texas were also found to have reduced survival rates, particularly those with acute myeloid leukemia and hepatoblastoma.
In February 2024, the US EPA tightened its PM2.5 air quality standard from 12.0 to 9.0 µg/m³. Yet even exposure at levels meeting the new standard was associated with worse outcomes among childhood cancer survivors, prompting the researchers to warn that current regulations may not be protective enough for medically vulnerable populations.
The team found that families are becoming increasingly concerned. Surveys and focus groups at Texas Children’s Cancer and Hematology Center revealed that caregivers want guidance on minimising environmental risks but often struggle to find reliable information. Most clinicians, however, reported feeling unprepared to discuss air pollution or recommend mitigation strategies.
First author Omar Shakeel, MD, a pediatric hematologist and oncologist at Texas Children’s Hospital said: ‘Many families express frustration that there are not enough resources to prevent and reduce the impact of environmental pollutants on their kids. 96% of paediatric cancer providers reported in our study that an environmental referral service would help address these families’ concerns.’
Mark Miller, senior author of the study and an associate professor in UCSF’s Occupational and Environmental Medicine division added: ‘Medical providers receive little to no education or clinical training on the impacts of environmental pollutants like pesticides and wildfire smoke but need resources to better treat patients.’
To close this gap, UCSF’s Western States Pediatric Environmental Health Specialty Units are developing an environmental referral service in collaboration with the Pediatric Environmental Health Specialty Units. The programme will provide families with counseling, risk assessments and practical tools, including low-cost air quality monitors and do-it-yourself HEPA air purifiers.
Miller concludes: ‘If you believe children in every state should have the cleanest air, water, and environment, then we need policymakers, medical providers, and communities to come together.
‘Increasing federal funding for research and resources could help reduce children’s exposure to dangerous pollutants, while improving health and survival outcomes.’
The full research can be read here.