"I had him strip at the front door," said Wihlborg, clinical program manager for Vivo Health Work Well in Great Neck, N.Y., part of North-Shore LIJ Health System. "I didnít let him bring those clothes in the house."
Having worked as an occupational health nurse for nearly 20 years, Wihlborg knew there were dangerous toxins in the dust that turned her husbandís police uniform from blue to gray. For Wihlborg and several New York City area nurses, a recent federal health officialís ruling to add 50 different types of cancers to the list of illnesses covered by a $4.3 billion fund created to compensate people exposed to toxic smoke, dust and fumes after the terrorist attacks on the World Trade Center and Pentagon validates what they long have suspected.
Although some of the post-9/11 sicknesses such as asthma, chronic obstructive pulmonary disease, chronic sinusitis and gastroesophageal reflux disease were more immediate and easier to identify, Wihlborg and other healthcare experts expected other diseases such as cancer to emerge.
Help for patients
The ruling, made by John Howard, director of the National Institute for Occupational Safety and Health, allows rescue workers and first responders, volunteers, residents, students and others to apply for compensation for cancers developed after exposure to toxins related to the attacks.
According to the Centers for Disease Control and Prevention website, cancers such as thyroid, bladder, lung, kidney, breast and ovarian are among those being recommended for compensation by the CDCís World Trade Center Health Program Scientific and Technical Advisory Committee.
"For patients who donít have insurance or are underinsured, this rulingís going to cover their cancer," said Joan Kaiser, RN, MA, AOCN, director of nursing for oncology at Columbia University Medical Center. "Thereís a population of patients who will postpone treatment because they canít afford it. This would then make it affordable or at least make healthcare accessible to that population."
Kaiser said she knows of at least two patients, one of them a rescue worker, who experienced exposure in the aftermath of the 9/11 attacks. One had lung cancer and the other had mesothelioma of the peritoneal cavity.
"We may start to see more of them," Kaiser said. "Itís cause and effect. It can take time. It can take years [to develop cancer]."
Although there is no strong evidence linking Ground Zero to cancer, Gary Shelton, RN, MSN, NP, ANP-BC, AOCNP, nurse practitioner at NYU Clinical Cancer Center, said the ruling could help push experts to further explore such a link. He points to the New York Fire Department study published in September 2011 in The Lancet. The study found a 20% higher rate of cancer in firefighters who were exposed to toxic smoke, dust and fumes at the World Trade Center than firefighters who were not exposed. Howard has cited the study as part of his decision to include cancers in the fund.
"Some of the data may not come out for years to come," Shelton said.
Connecting the dots
Still, the ruling might raise awareness about a possible connection between cancer and 9/11, Shelton said, and encourage nurses and other healthcare providers to better question patients who could have been at or near Ground Zero after the attack.
Dennis Graham, RN, ANP, DNSc, nurse practitioner clinical program director at Memorial Sloan-Kettering Cancer Center in New York, agrees. His facility has treated at least a dozen patients who were exposed to 9/11 toxins, including two firefighters with lymphomas. Graham also has seen a leukemia patient and two other patients with colorectal cancer. The ruling and the list of cancers makes it more important than ever for nurses to ask the right questions about historical events in patientsí lives, which could improve care and help patients find assistance, such as compensation from the fund. A simple question such as, "What did you do for a living?" could connect the dots, Graham said.
"I think in healthcare in general and in nursing and medicine, weíre more interested in taking care of the health issues of the person in front of us than finding the root causes," Graham said. "One of the roles of nursing is to teach and counsel patients about health maintenance and prevention and illness, so if we leave [historical events] off the list of questions, weíre not practicing at a level we should be practicing."
Graham, whose brother was a first responder for the New York Police Department and later experienced pulmonary problems, said other conditions in a cancer patient, such as respiratory issues, could be another clue that might be traced to Ground Zero.
Graham is planning a lecture at Memorial Sloan-Kettering to teach nurses about the significance of asking patients about major events in their lives, such as 9/11. For some patients, knowing a cause of their disease can help them move forward in the treatment process, Shelton said.
As nurses look back on those early days after Sept. 11, many of them are surprised about the initial lack of protection available to workers and volunteers.
"Itís pretty amazing nobody thought about that when it happened," Graham said. "Obviously this dust and smoke couldnít be good for you." •
Geneva Slupski is a freelance writer.
FOR INFORMATION about the National Institute for Occupational Health and Safetyís decision about the health impact of 9/11, visit CDC.gov/Niosh/Topics/Wtc/Stac/Cancer.html.
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