Integrating environmental risk factors into pediatric cancer care: Laying the groundwork for improved outcomes and primary prevention

Abstract

Childhood cancer incidence has steadily risen both in the United States and worldwide, yet its environmental contributors remain underrecognized in clinical care. Children and cancer survivors are particularly susceptible to environmental exposures due to their unique physiology and the long-term health vulnerabilities that follow cancer treatment. Although exposures to substances such as pesticides, air pollution, and household chemicals are linked to increased cancer risk, limited clinical frameworks and clinician training leave oncologists underprepared to address growing environmental health concerns from families. A holistic pediatric oncology environmental health program in Murcia, Spain offers a scalable vision for embedding the environment into longitudinal cancer care. In the United States, survey data from two large academic pediatric cancer centers revealed strong clinician interest in addressing environmental health in pediatric oncology, leading to the development of a consultative model. Workshops and a standardized environmental health history tool, adapted for clinical use and integration into the medical record, have laid the groundwork for implementation of an environmental consult service across 3 care settings: cancer predisposition clinics, survivorship programs, and as requested. These efforts aim to reduce family anxiety, offer actionable risk-reduction strategies, and empower primary teams with the knowledge to engage in meaningful conversations. The patient-centered tools, interdisciplinary training, and structured integration into clinical workflows are designed to strengthen environmental health knowledge and practice of pediatric oncologists in the United States.