Climate Change and Its Effects on the Palliative Care Continuum and Quality of Life among Women with Breast Cancer at Ho Teaching Hospital

1. Background

Climate change has emerged as a critical global health threat, with far-reaching implications for disease patterns, health systems, and vulnerable populations, including individuals requiring palliative care [1]. The increasing frequency and intensity of climate-related events such as heatwaves, floods, and air pollution episodes have been shown to exacerbate chronic illnesses, disrupt healthcare delivery, and compromise the quality of life of patients with life-limiting conditions [2,3]. Women with breast cancer represent a particularly vulnerable group, as they often experience complex symptom burdens and require continuous, coordinated care across the palliative care continuum [4]. Climate change-related disruptions can therefore intensify physical symptoms, psychological distress, and social vulnerabilities, ultimately undermining palliative care outcomes [5].

Globally, breast cancer remains the most commonly diagnosed cancer among women, with significant morbidity and mortality, particularly in low- and middle-income countries (LMICs) [6]. The integration of palliative care into cancer management is widely recognized as essential for improving quality of life, yet climate-sensitive health systems are often inadequately prepared to sustain such services during environmental crises [4]. Evidence indicates that extreme weather events can interrupt medication supply chains, limit access to healthcare facilities, and exacerbate inequities in care delivery, particularly for patients requiring long-term supportive and palliative interventions [7].

In Africa, the dual burden of rising cancer incidence and climate vulnerability presents a significant public health challenge [8]. Many African health systems face structural constraints, including limited infrastructure, workforce shortages, and inadequate integration of palliative care services, which are further strained by climate-related shocks [1]. Breast cancer outcomes in Africa are often poor due to late diagnosis and limited access to comprehensive care, and climate change may exacerbate these disparities by disrupting already fragile healthcare systems [9]. Furthermore, socio-economic vulnerabilities, gender inequities, and cultural factors intersect with environmental stressors, compounding the challenges faced by women undergoing cancer treatment and palliative care [10].

In sub-Saharan Africa, the situation is particularly concerning, as the region is highly susceptible to climate variability and extreme weather events [11]. Health systems in this region often lack resilience to withstand climate-induced disruptions, resulting in compromised continuity of care for patients with chronic and life-limiting illnesses [12]. Studies have highlighted that patients with cancer in sub-Saharan Africa face significant barriers to accessing palliative care, including geographic inaccessibility, financial constraints, and limited availability of essential medications, all of which may be worsened by climate-related challenges [13]. Consequently, climate change may indirectly and directly influence symptom management, psychosocial support, and overall quality of life among women with breast cancer in the region [14].

In Ghana, breast cancer is the leading cause of cancer-related morbidity and mortality among women, with many patients presenting at advanced stages requiring palliative care [15]. Although efforts have been made to integrate palliative care into the healthcare system, services remain limited and unevenly distributed, particularly outside major urban centers [16]. Ghana is also increasingly experiencing the effects of climate change, including rising temperatures, flooding, and environmental degradation, which can disrupt healthcare access and exacerbate health vulnerabilities [17]. For women with breast cancer receiving care at facilities such as Ho Teaching Hospital, these environmental stressors may affect treatment adherence, symptom control, and psychosocial well-being, yet empirical evidence on this intersection remains scarce [18].

Despite growing global recognition of the health impacts of climate change, there is a paucity of empirical research examining its specific effects on the palliative care continuum, particularly among women with breast cancer in LMICs [1]. Existing studies have largely focused on acute health outcomes and infectious diseases, with limited attention to chronic and life-limiting conditions requiring long-term supportive care [19,20]. In Africa and sub-Saharan Africa, research on palliative care remains underdeveloped, and the intersection with climate change is even less explored, creating a significant knowledge gap [21,22]. In Ghana specifically, there is a lack of context-specific evidence on how climate-related factors influence the quality of life and care experiences of women with breast cancer within the palliative care continuum. This study seeks to address these gaps by exploring the effects of climate change on the palliative care continuum and quality of life among women with breast cancer at Ho Teaching Hospital in Ghana

2. Materials and Methods

2.1. Study Design

This study employed a qualitative descriptive phenomenological design to examine how climate change influences the palliative care continuum and quality of life among women with breast cancer at Ho Teaching Hospital. The choice of design enabled participants to narrate their lived experiences, particularly how environmental stressors—such as extreme weather events, heat exposure, and resource disruptions—intersect with symptom burden, care access, and psychosocial wellbeing [23]

2.2. Participants and Sampling

The study population consisted of women diagnosed with breast cancer who were receiving or had previously received palliative care services at Ho Teaching Hospital in Ghana. A purposive sampling strategy was used to recruit participants with rich and relevant experiences related to both cancer care and environmental challenges affecting their wellbeing. Recruitment continued until data saturation was achieved, defined as the point at which no new insights or themes emerged from subsequent interviews [24]. To be included in the study, participants needed to be aged 18 years or older, have a confirmed diagnosis of breast cancer, and be enrolled in or have experience with palliative care services. Participants were also required to have lived through at least one climate-related event [e.g., extreme heat, flooding, or seasonal disruptions) that could influence their care experience or quality of life. Women with severe cognitive impairment or critical illness that limited their ability to participate meaningfully in interviews were excluded to ensure data quality and ethical integrity.

2.3. Procedures and Data Collection

Data were collected through semi-structured, in-depth interviews using an interview guide informed by existing literature on palliative care, breast cancer, quality of life, and climate-related health impacts. The interview guide explored participants’ experiences of symptom management, access to care, environmental challenges, coping strategies, and perceived effects of climate variability on their physical, emotional, and social wellbeing. Interviews were conducted face-to-face in a quiet and private setting within Ho Teaching Hospital to ensure confidentiality and participant comfort. Each interview lasted approximately 45 to 60 minutes and was conducted in English with participants’ consent. All interviews were audio-recorded, and detailed field notes were taken to capture non-verbal expressions and contextual factors relevant to the study. Data collection proceeded concurrently with data analysis until saturation was reached on the 14th participant.

2.4. Data Processing and Analysis

All interviews were transcribed verbatim and cross-checked against the audio recordings to ensure accuracy. Identifying information was removed, and participants were assigned unique codes to maintain anonymity. Data were analyzed using the conventional content analysis approach described by Graneheim and Lundman, which involves systematic identification of coding, and the development of sub-themes and themes [25]. An inductive analytic process was followed, allowing themes to emerge directly from the data. The analysis progressed from initial open coding to the abstraction of sub-themes and overarching themes that captured the interplay between climate-related factors, palliative care experiences, and quality of life outcomes.

2.5. Ethical Consideration

The study was conducted in accordance with the Declaration of Helsinki on ethical principles for medical research involving human participants. Ethical approval was obtained from the Institutional Review Board of the Ho Teaching Hospital (Protocol No. HTH-REC/EX/2026/003). In addition, written informed consent was obtained from all study participants prior to their inclusion in the study. Participants were fully informed about the purpose of the study, the voluntary nature of their participation, the procedures involved, and their right to withdraw at any time without any consequences to their care or services received. Confidentiality and anonymity were strictly maintained throughout the study. No identifying information was collected, and all data were stored securely and used solely for research purposes. The study posed minimal risk to participants, and all procedures were carried out in a manner that ensured privacy, dignity, and respect for participants’ rights.

2.6. Rigor

To ensure methodological rigor, several strategies were employed. Credibility was enhanced through member checking and peer debriefing. Dependability and confirmability were supported by maintaining a detailed audit trail documenting all analytical decisions. Reflexivity was upheld through the use of reflective journals, enabling continuous critical examination of the researchers’ assumptions and minimizing potential bias throughout the research process [26].

3. Results

3.1. General Characteristics of the Participants

The participants consisted of 14 (n = 14) women with breast cancer receiving palliative care at Ho Teaching Hospital. Their ages ranged from 39 to 62 years, with a mean age of 49.0 years (SD = 7.2). The majority of participants (12 of 14) were married, while two were widowed. All participants had experienced at least one pregnancy, with the number of pregnancies ranging from one to five and a mean of 2.57 (SD = 1.09). Details of the general characteristics of the participants are presented in Table 1.

3.2. Themes and Sub-Themes That Emerged from the Data

In all four main themes and thirteen sub-themes emerged: (1) Climate-related environmental disruptions (extreme heat, flooding, and unreliable electricity supply); (2) Health-related consequences along the palliative care continuum [symptom exacerbation, treatment interruptions, and reduced care accessibility); (3) Psychosocial and economic strain (emotional distress, financial hardship, food and water insecurity); and (4) Adaptive and coping responses (spiritual coping, family support, and reliance on healthcare providers and community networks).

Table 2. Themes and Sub-themes that emerged from the study.

Theme	Sub-theme
1. Climate-Related Environmental Disruptions	Extreme Heat Flooding Events Unreliable Electricity Supply
2. Health-Related Consequences Along the Palliative Care Continuum	Symptom Exacerbation Treatment Interruptions Reduced Care Accessibility
3. Psychosocial and Economic Strain	Emotional Distress Financial Hardship Food and Water Insecurity
4. Adaptive and Coping Responses	Spiritual Coping Family Support Healthcare Provider Support Community Networks

Table 2. Themes and Sub-themes that emerged from the study.

Theme	Sub-theme
1. Climate-Related Environmental Disruptions	Extreme Heat Flooding Events Unreliable Electricity Supply
2. Health-Related Consequences Along the Palliative Care Continuum	Symptom Exacerbation Treatment Interruptions Reduced Care Accessibility
3. Psychosocial and Economic Strain	Emotional Distress Financial Hardship Food and Water Insecurity
4. Adaptive and Coping Responses	Spiritual Coping Family Support Healthcare Provider Support Community Networks

3.2.1. Theme One: Climate-Related Environmental Disruptions

Three sub-themes emerged under this theme: Extreme Heat, Flooding Events, and Unreliable Electricity Supply. These environmental disruptions were reported to directly and indirectly affect both patients and the delivery of palliative care services.

Sub-theme 1: Extreme Heat

Participants described increasingly high temperatures that aggravated physical discomfort, particularly among women receiving palliative care for breast cancer. Heat exposure was also linked to fatigue and poor rest.

“The heat is too much these days. Sometimes I cannot even sleep at night because of it.” [P3).

“When it becomes very hot, my body pains increase and I feel weaker than usual.” (P11).

Sub-theme 2: Flooding Events

Participants reported seasonal flooding that disrupted transportation and access to health facilities, especially during heavy rains.

“When it rains heavily and there is flooding, I cannot go to the hospital for my appointments.” (P7).

“Sometimes the roads are cut off, so even the nurses cannot reach us or we cannot reach them.” (P14).

Sub-theme 3: Unreliable Electricity Supply

Frequent power outages were described as affecting both home care and hospital-based services, including medication storage and comfort.

“Sometimes there is no light for days, and it becomes difficult to keep things like drugs properly.” (P2).

“The heat becomes worse when there is no electricity for fans or cooling.” (P9).

3.2.2. Theme Two: Health-Related Consequences Along the Palliative Care Continuum

Three sub-themes emerged: Symptom Exacerbation, Treatment Interruptions, and Reduced Care Accessibility. These reflected how climate-related factors compromised continuity and quality of palliative care.

Sub-Theme 1: Symptom Exacerbation

Participants indicated that environmental stressors worsened cancer-related symptoms such as pain, fatigue, and general discomfort.

“My pain becomes worse when the weather is very hot.” (P5).

“I feel more tired and weak when the conditions around me are not comfortable.” (P12).

Sub-Theme 2: Treatment Interruptions

Climate events such as flooding and transport disruptions were reported to delay or interrupt scheduled chemotherapy or follow-up visits.

“I missed my hospital appointment because the rains flooded the road.” (P8).

“Sometimes I have to postpone treatment because I cannot travel when the weather is bad.” (P1).

Sub-Theme 3: Reduced Care Accessibility

Participants noted reduced access to healthcare services due to distance barriers, transport challenges, and disrupted facility operations.

“It is not always easy to reach the hospital when the weather is bad.” (P6).

“Even when I want to go, transport is not available during heavy rains.” (P13).

3.2.3. Theme Three: Psychosocial and Economic Strain

Three sub-themes emerged: Emotional Distress, Financial Hardship, and Food and Water Insecurity. These reflected the broader social and economic burden of climate-sensitive palliative care challenges.

Sub-Theme 1: Emotional Distress

Participants expressed anxiety, worry, and psychological strain associated with worsening environmental and health conditions.

“I feel very anxious when I think about how I will cope during extreme weather.” (P4).

“Sometimes I become stressed because everything feels difficult at once.” (P10).

Sub-Theme 2: Financial Hardship

Increased costs related to transport, treatment, and household needs during climate disruptions were frequently reported.

“I spend more money on transport when the rains come because it is difficult to travel.” (P7).

“Sometimes I cannot afford all the things I need when everything becomes expensive during bad weather.” (P2).

Sub-Theme 3: Food and Water Insecurity

Participants reported difficulties accessing safe food and clean water during flooding and other climate-related disruptions.

“During floods, getting clean water becomes a challenge.” (P11).

“Sometimes food becomes scarce and expensive, and it affects my health.” (P14).

3.2.4. Theme Four: Adaptive and Coping Responses

Four sub-themes emerged: Spiritual Coping, Family Support, Healthcare Provider Support, and Community Networks. These reflected the resilience strategies used to manage climate and health-related challenges.

Sub-Theme 1: Spiritual Coping

Participants relied on faith, prayer, and religious beliefs to cope with uncertainty and hardship.

“I always pray and ask God to give me strength to endure everything.” (P9).

“My faith helps me to remain calm even when things are difficult.” (P3).

Sub-Theme 2: Family Support

Family members provided emotional, physical, and financial assistance during periods of illness and environmental hardship.

“My family helps me a lot, especially when I cannot move during bad weather.” (P5).

“They support me with transport money and also take care of me at home.” (P12).

Sub-Theme 3: Healthcare Provider Support

Participants highlighted the role of nurses and doctors in offering reassurance, guidance, and continuity of care.

“The nurses always encourage me even when I miss appointments because of the weather.” (P1).

“Doctors explain things well and that gives me hope.” (P8).

Sub-Theme 4: Community Networks

Community members and informal support systems played a role in helping patients navigate environmental and health challenges.

“My neighbors sometimes check on me when I cannot go out.” (P6).

“In my community, some people help with transport when things are difficult.” (P13).

4. Discussion

This study explored climate change and its effects on the palliative care continuum and quality of life among women receiving breast cancer care at Ho Teaching Hospital, identifying four interrelated domains: climate-related environmental disruptions, health-related consequences along the palliative care continuum, psychosocial and economic strain, and adaptive and coping responses. While these findings resonate with emerging global evidence on climate-sensitive health systems, their manifestation within the Ghanaian context reflects a complex intersection of environmental vulnerability, infrastructural limitations, and socio-economic fragility [27]. Importantly, the findings demonstrate that palliative care experiences are increasingly shaped not only by disease trajectories but also by environmental determinants of health [28].

The persistent reports of extreme heat experienced by participants reflect broader global climate trends, particularly rising ambient temperatures in tropical and sub-Saharan regions. Extreme heat is increasingly recognized as a public health stressor that exacerbates morbidity among individuals with chronic and advanced illnesses [29,30]. In this study, women described worsening pain, fatigue, and sleep disturbances during periods of intense heat. These findings align with evidence that heat stress intensifies symptom burden among cancer and palliative care populations [31]. However, in the Ghanaian context, the absence of climate-adaptive healthcare infrastructure—such as reliable cooling systems in homes and health facilities—appears to amplify discomfort and reduce physiological resilience. Unlike high-income settings where environmental controls are more readily available, patients in this context rely on limited coping mechanisms, often exacerbating vulnerability.

Similarly, flooding events emerged as a significant barrier to continuity of care, particularly in relation to access to health facilities. Participants consistently reported missed appointments, delayed care, and physical inaccessibility due to impassable roads during heavy rains. This reflects the growing recognition that climate-induced disasters disproportionately disrupt healthcare access in low- and middle-income countries (LMICs), where transport infrastructure is often fragile and poorly maintained [32,33]. While similar disruptions have been documented globally, the frequency and severity of access barriers in this setting underscore the compounding effects of geographical vulnerability and weak health system resilience. Consequently, flooding is not merely an environmental event but a structural determinant of interrupted palliative care delivery.

Unreliable electricity supply further compounded these challenges by directly affecting both home-based and facility-based care. Participants highlighted difficulties in medication storage, reduced comfort due to lack of cooling systems, and general deterioration in quality of life during power outages. These findings are consistent with evidence that energy insecurity significantly undermines healthcare delivery, particularly for patients requiring continuous symptom management and temperature-sensitive medications [34,35]. In the Ghanaian context, intermittent electricity supply reflects broader infrastructural constraints, which interact with climate stressors to produce cumulative vulnerability [36]. Thus, energy instability becomes an indirect but critical determinant of palliative care quality.

The health-related consequences identified—particularly symptom exacerbation, treatment interruptions, and reduced care accessibility—demonstrate the direct interface between environmental stressors and clinical outcomes. Participants reported worsening pain and fatigue during extreme heat, consistent with literature indicating that environmental stress can amplify symptom perception and reduce physiological tolerance [37,38]. These findings suggest that symptom burden in palliative care is not solely disease-driven but environmentally mediated. Thus, treatment interruptions due to flooding and transport disruptions further highlight how climate variability undermines continuity of oncology and palliative care services [19,39]. In LMICs, where appointment adherence is already challenged by financial and logistical barriers, climate events introduce an additional layer of unpredictability [40]. Reduced accessibility to care therefore reflects a convergence of environmental, infrastructural, and socio-economic constraints.

The psychosocial and economic strain reported by participants further illustrates the multidimensional impact of climate-sensitive palliative care disruptions. Emotional distress, characterized by anxiety and uncertainty about coping with environmental extremes, reflects the psychological burden of living with both advanced illness and environmental instability. Similar findings have been reported in climate-health literature, where climate anxiety is increasingly recognized as a determinant of mental health outcomes [41,42]. However, in this study, distress is intensified by the co-occurrence of serious illness, making adaptation more complex.

Financial hardship emerged as another critical consequence, with participants reporting increased transport costs, healthcare expenses, and household pressures during adverse weather conditions. This aligns with evidence that climate-related disruptions disproportionately affect economically vulnerable populations, exacerbating out-of-pocket healthcare expenditure [43,44]. In Ghana and similar settings, where health insurance coverage may not fully absorb indirect costs, climate shocks deepen existing financial inequities in healthcare access.

Food and water insecurity further compounded participants’ vulnerability, particularly during flooding events that disrupted supply chains and access to safe resources. These findings are consistent with global evidence linking climate variability to food insecurity and water contamination, particularly in flood-prone regions [45]. For women receiving palliative care, compromised nutrition and hydration not only worsen clinical outcomes but also reduce treatment tolerance and quality of life.

Despite these challenges, the study identified multiple adaptive and coping responses that reflect resilience within constrained systems. Spiritual coping emerged as a dominant mechanism, with participants drawing strength from prayer and religious faith. This aligns with evidence that spirituality serves as a key psychosocial resource in African health contexts, particularly in managing chronic and life-limiting conditions [46,47]. In this setting, spirituality functions not only as emotional support but also as a framework for meaning-making in the face of environmental and health uncertainty.

Family support played a central role in buffering the effects of climate-related disruptions. Participants described receiving emotional, physical, and financial assistance, particularly during periods of environmental hardship. This finding is consistent with collectivist cultural norms in Ghana and broader sub-Saharan Africa, where caregiving is strongly family-centered [48,49]. However, it also highlights the extent to which informal systems compensate for gaps in formal healthcare and disaster preparedness structures.

Healthcare provider support further contributed to resilience, with participants valuing reassurance, guidance, and continuity of care from nurses and doctors. This underscores the importance of empathetic communication in mitigating anxiety and strengthening trust in health systems, particularly under conditions of uncertainty [50,51]. Nevertheless, the effectiveness of this support is constrained by systemic limitations, including workload pressures and limited integration of climate-resilient care practices within oncology and palliative care services.

Finally, community networks emerged as an important but often under-recognized source of support. Neighbors and community members provided assistance with transport, monitoring, and basic needs during periods of environmental disruption. This reflects the broader role of social capital in enhancing health system resilience in resource-limited settings [52].

5. Conclusions

This study highlights that climate-related environmental disruptions, particularly extreme heat, flooding, and unreliable electricity supply, significantly affect the palliative care continuum and quality of life among women with breast cancer at Ho Teaching Hospital. These environmental challenges contribute to symptom worsening, interruptions in care, and increased psychosocial and economic strain. Despite these difficulties, patients demonstrate notable adaptive capacities through spiritual beliefs, family support, healthcare provider engagement, and community networks. Overall, the findings suggest that climate variability is an important contextual factor influencing palliative care experiences and should be considered in efforts to improve continuity and quality of care.