Shaping the Future of Oncology Nursing and Climate Health

Climate change is often discussed in terms of melting ice caps and rising sea levels. But for Associate Professor AnnMarie L. Walton, PhD, RN, MPH, OCN, CHES, FAAN, the issue is inseparable from human health, particularly in cancer care. A nationally recognized oncology nurse researcher, Dr. Walton’s work increasingly focuses on how climate change is both amplifying cancer risk and disrupting cancer care across the continuum.

According to a recent survey co-authored by Dr. Walton appearing in the Clinical Journal of Oncology Nursing, while a majority of oncology nurses are familiar with the causes and effects of climate change, and are concerned about its health impacts, most lack awareness of the U.S. healthcare industry’s impact on climate change—accounting for 8.5% of greenhouse gas emissions in the nation—as well as information on steps they can take to advocate for change. Dr. Walton and her coauthors suggested that nurses’ knowledge gap could be closed with “education and training on evidence-based strategies for mitigating and responding to climate change.”

In a recent visiting lecture for the University of Minnesota’s School of Nursing, Dr. Walton shared how nurses can equip themselves to become knowledgeable and skilled providers with regard to climate-related health conditions, as well as change agents in planetary health.

“Climate change is not a distant environmental issue,” she emphasized. “It’s a health issue that is showing up in our clinics, hospitals, and communities right now.”

When Climate Change Shows Up at the Bedside

Referring to public health data, Walton described how climate-driven changes—extreme heat, worsening air quality, severe weather, and changing disease patterns—translate into real-world health consequences.

“What we see as clinicians is what’s on the outermost ring,” she said, referring to the CDC’s climate and health framework. “People showing up in the emergency department for heat-related illness, cardiovascular events, asthma exacerbations, injuries, and mental health impacts after extreme weather.”

Air pollution alone, Walton noted, is responsible for millions of deaths each year and is a major contributor to cardiovascular disease, stroke, COPD, and lung cancer.

“When we’re seeing these chronic conditions on the rise, we have to think about the impact of climate change as well,” she said.

Walton noted that these health impacts are not evenly distributed, with children, older adults, people with chronic illness, those who live or work outdoors, and communities of color facing disproportionate risks.

“The adverse health outcomes of climate change are not shared equally across populations,” Dr. Walton said.

Climate Change and Cancer Risk

As an oncology nurse, Dr. Walton’s research lens is on cancer. Climate change, she explained, worsens multiple known carcinogenic exposures.

“UV radiation should automatically come to mind,” she said. “It’s a complete carcinogen—it’s both a tumor initiator and a tumor promoter.”

Air pollution is another major concern, linked to a significant proportion of lung cancers worldwide. Climate-driven wildfires further intensify exposure, while also limiting opportunities for protective behaviors like outdoor physical activity.

Dr. Walton also highlighted less visible yet deeply concerning risks, including radon exposure, declining nutritional quality of food, and carcinogens released from damaged buildings after floods and fires.

“Buildings are built with carcinogens—things like asbestos, arsenic, chromium, and cadmium,” she explained. “When buildings burn or flood, those substances don’t disappear. They end up in the air, the water, and the people who are trying to clean things up.”

Disrupting Cancer Care

Climate change doesn’t just increase cancer risk, Dr. Walton highlighted, but also cancer care itself.

She pointed to evidence showing that extreme weather delays screening, interrupts treatment, disrupts the oncology workforce, and worsens long-term outcomes for patients across multiple cancer types.

“Both things are true,” she said. “Therapy can be interrupted. But even if you complete treatment, returning to a community that’s experienced an extreme weather event is associated with worse outcomes.”

End-of-life care is affected as well, with climate-related disasters increasing isolation and caregiver burden during an already vulnerable time.

Healthcare’s Own Climate Footprint

Dr. Walton was up front about healthcare’s role in planetary health. “If global healthcare were a country, it would be the fifth-largest climate polluter on the planet,” she said, noting that hospitals are among the most energy- and water-intensive buildings in the U.S. and generate enormous amounts of waste—much of it from single-use plastics derived from fossil fuels.

“The way that we’re going about healing and helping people is actually making our planet sick,” Dr. Walton said. “That tension is something we have to confront.”

Nursing Leadership in Climate Action

The path forward, Dr. Walton said, must have nurses in leadership roles shaping the future, with nurses uniquely positioned to drive change at every level, from bedside practice to health system policy.

“We are not just influencing policymakers. Nurses are policymakers,” Dr. Walton said. “The more often we are at the table, the less often we are on the menu.”

That leadership, she said, can take many forms: reducing waste in clinical settings, asking patients about environmental exposures, advancing sustainable procurement, engaging in interdisciplinary research, and advocating through professional organizations.

Finding Joy and Hope in Challenging Work

Dr. Walton closed her talk on a hopeful note grounded in community, collaboration, and work on behalf of future generations.

“The fact that you’re here today, the fact that you care, the fact that you’re going to educate somebody else—that gives me hope,” she said.