Surviving Cancer...and Blizzards

Published: October 30, 2026

By Mara Johnson-Groh

4 min read

New Englanders are no strangers to severe weather, knowing how to prepare and when to avoid dangerous roads. So when a blizzard strikes, or flooding hits, people don’t always venture out—including for medical appointments.

However, hunkering down and delaying medical care can influence how effective that care ultimately is, says Katie Lichter, MD, MPH, an assistant professor of radiation oncology and health policy at Dartmouth Cancer Center. She has seen her own patients skip appointments due to concerns about their ability to safely reach the clinic.

“Climate change is increasing the frequency and severity of extreme weather events, which directly disrupts our ability to deliver continuous care,” Lichter says. “I see it in my practice today—winter storms and flooding are causing missed visits, which only intensifies the emotional, physical, and financial strain on our most vulnerable patients.”

That’s why Lichter is studying climate change’s impacts on cancer care. And, as director of Dartmouth Cancer Center’s new Division of Resilient and Sustainable Cancer Care, she is devising ways to reduce these deadly disruptions.

Where There’s Smoke

Lichter first began to understand the impacts of climate change on healthcare during her residency in San Francisco.

“I was caring for patients in the ICU whose lung cancer had rapidly worsened due to widespread wildfires at the time,” Lichter says. “The wildfires acted as a threat multiplier. Not only were patients exposed to dangerous smoke, but evacuations and road closures meant they couldn’t safely access their regular care facilities.”

Today, Lichter applies her experience in California at Dartmouth. Though wildfires are less of a risk in New England, severe weather like winter storms, heat waves, and flooding also cause missed appointments, especially for rural residents.

“We know it’s absolutely critical not to miss visits because continuous care directly impacts patient outcomes,” she says. “Even a few missed appointments can compromise the effectiveness of a patient’s treatment.”

An Early Warning System

By combining medical records with local and national weather data, Lichter is investigating how many Cancer Center patients miss visits due to extreme weather and which populations are most at risk.

For example, she looked at a November 2025 winter storm and found that one in ten patients missed their medical appointments during the week of that storm. Those absences were ten times higher than the number of missed appointments due to wildfires in California, which Lichter had reported in The Journal of Climate Change and Health in 2025.

A woman stands with her hands in her jacket pockets, backlit by the sun rising through fog, her image reflected in a puddle. — Katie Lichter, MD, MPH, has seen patients fall behind on treatments due to extreme weather. She’s working to prevent those interruptions. *Credit: Robert Gill*

Lichter is harnessing her winter storm findings (not yet published) to develop a proactive early warning system called the WEATHER-Care project. Supported by an American Cancer Society Institutional Research Grant and the Dartmouth Climate Collaborative, the Lichter lab plans to launch the system this winter. It will be the first of its kind in the nation.

WEATHER-Care would text patients who have appointments within 48 hours that a weather event is coming. The text would also communicate rescheduling and telehealth options. Lichter and her team hope the system can meaningfully reduce treatment disruptions.

Ultimately, she aims to extend her work beyond winter storms. “We need to look at the whole picture. It’s not just about knowing who lives on an unpaved, unplowed road,” Lichter says. “We also need to identify which patients might have reduced kidney function from chemotherapy, or comorbidities like diabetes, that put them at severe medical risk during high heat days.”

Fewer Visits; Fewer Drives

Lichter is also exploring whether changing cancer treatments themselves could help, too. One new radiation technique holds promise. Called hypofractionation, it increases the radiation dosage per session, contracting treatment schedules from weeks to days and significantly reducing patients’ travel days.

Lichter has also studied ways to reduce appointments, such as timing breast cancer screenings to personal indicators, instead of just age, to minimize how often a low-risk patient must come in.

These approaches both reduce patient burden with no decrease in care quality and carry a lighter environmental footprint. This dual focus on building climate resilience while actively advancing healthcare decarbonization is a core mission of the Lichter lab.

This work, Lichter notes, wouldn’t be possible without the support of Charles Thomas Jr., MD, chair of the Department of Radiation Oncology and Applied Sciences at the Cancer Center, whose leadership has helped bring Dartmouth Health to the national forefront of sustainable healthcare.

“We must recognize that sustainability matters deeply to the health of our future communities and to many patients themselves,” Lichter says. “By addressing the true environmental and human costs of our care pathways, we can actively reduce tomorrow’s cancer burden.”

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