3722 - Evaluating the Impact of Wildfires on Radiotherapy Compliance and Financial Costs: Insights from a Multi-Clinic Analysis

R. Sabol¹, C. J. Walsh², S. Densley³, A. Krishna⁴, C. Baiyee⁵, D. Meltzer⁶, J. Boscardin⁶, A. Wiztum⁷, N. Pitts⁶, A. K. Paulsson⁸, J. Y. Luh⁹, L. Zalavari¹⁰, S. S. Yom¹¹, and K. Lichter¹²; ¹Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, ²University of Colorado School of Medicine, Aurora, CO, ³Florida Atlantic University College of Medicine, Boca Raton, FL, ⁴Lexington Medical Center, West Columbia, SC, ⁵Ohio State College of Medicine, Columbus, OH, ⁶University of California, San Francisco (UCSF), San Francisco, CA, ⁷Department of Radiation Oncology, University of California, San Francisco (UCSF), San Francisco, CA, ⁸University of California, San Francisco, San Francisco, CA, ⁹Providence St. Joseph Health, Eureka, CA, ¹⁰Stanford Health Care, Stanford, CA, United States, ¹¹University of California San Francisco, San Francisco, CA, ¹²University of California, San Francisco Department of Radiation Oncology, San Francisco, CA

Purpose/Objective(s): Amidst escalating climate change, wildfires have become a pressing concern, potentially disrupting oncological care continuity. This study aims to explore the relationship between wildfire occurrences in Northern California from 2017 to 2021 and adherence to scheduled radiotherapy appointments. It further seeks to quantify the financial implications of such environmental crises on healthcare delivery, aiming to inform targeted interventions and policy adjustments to sustain oncology care services during wildfires. Materials/

Methods: A retrospective analysis was conducted on 539,292 radiotherapy appointments across eight clinics in Northern California, which included rural and urban, community and academic centers, correlating these with CAL FIRE wildfire data. Logistic regression analyses adjusted for seasonal variations, clinic-specific effects, and temporal trends were utilized to examine the association between wildfire proximity (within 50 km) and appointment adherence. Additionally, the study assessed the financial impact of missed appointments, calculating the cost based on average technical expenses per visit from one institutions financial records.
Results: During the study period, 8.8% of radiotherapy appointments coincided with active wildfires within a 50 km radius of the clinics, with an overall missed appointment rate of 4.9%. Univariable analysis indicated a slight increase in missed appointments during wildfire events (OR = 1.06, 95% CI [1.00, 1.11], p=0.039). Multivariable analysis, controlling for seasonality, temporal trends, and clinic-specific factors, revealed a stronger association (OR = 1.07 [1.02, 1.13], p=0.007) with adjusted missed rates of 4.8% and 5.2%, respectively. The financial analysis estimated that the missed appointments during active wildfires resulted in a total cost of approximately $2.14 million.
Conclusion: This investigation underscores a significant, albeit modest, increase in non-adherence to radiotherapy appointments during wildfires, highlighting the need for strategic planning and policy development to mitigate such impacts. The financial burden of missed appointments emphasizes the broader economic implications of climate-related healthcare disruptions. Future research should aim to identify patient demographics, clinic characteristics, and disease sites most at risk, guiding the development of robust disaster preparedness and response strategies within the oncological care sector.