Cancer patients are among the most vulnerable populations in the aftermath of a disaster. They are at higher risk of medical complications and death due to the collapse or disruptions in the healthcare system, the community infrastructure, and the complexity of cancer care. The United Nations' Sendai Framework for Disaster Reduction states that people with life-threatening and chronic diseases should be considered in disaster plans in order to manage their risks. With extreme weather or disasters becoming more intense and frequent and the high burden of cancer in the U.S. and its territories, it is important to develop region-specific plans to mitigate the impact of these events on the cancer patient population. After hurricanes, Irma and Maria hit Puerto Rico and the U.S. Virgin Islands in 2017, the need to develop and implement such plans for cancer patients was evident. We describe ongoing efforts and opportunities for disseminating and implementing emergency response plans to maintain adequate cancer care for patients during and after disasters. While plans for cancer patients should be housed within the Emergency Support Function infrastructure of each jurisdiction, the Centers for Disease Control and Prevention's Comprehensive Cancer Control Plans provide excellent community-centered mechanisms to support these efforts.
Background: Hurricanes are the immediate ways that people experience climate impacts in the Caribbean. These events affect socio-ecological systems and lead to major disruptions in the healthcare system, having effects on health outcomes. In September 2017, Puerto Rico (PR) and the United States Virgin Islands (USVI) experienced one of the most catastrophic hurricane seasons in recent history (Hurricane Irma was a Category 5 and Hurricane María was a Category 4 when they hit PR). Objective: This study examines environmental stressors experienced by women with gynecologic (GYN) cancers from PR and USVI who received oncologic cancer care in PR, in the aftermath of the hurricanes. Methods: A descriptive qualitative study design was used to obtain rich information for understanding the context, barriers, knowledge, perspectives, risks, vulnerabilities, and attitudes associated to these hurricanes. We performed focus groups among GYN cancer patients (n = 24) and key-informant interviews (n = 21) among health-care providers and administrators. Interviews were conducted from December 2018–April 2019. Results: Environmental health stressors such as lack of water, heat and uncomfortable temperatures, air pollution (air quality), noise pollution, mosquitos, and rats ranked in the top concerns among cancer patients and key-informants. Conclusions: These findings are relevant to cancer patients, decision-makers, and health providers facing extreme events and disasters in the Caribbean. Identifying environmental secondary stressors and the most relevant cascading effects is useful for decision-makers so that they may address and mitigate the effects of hurricanes on public health and cancer care.
Objective: Cancer patients have increased risk of poor outcomes after disasters. On September 2017 Hurricanes Irma and María affected Puerto Rico (PR) and US Virgin Islands, causing the population to experience major disruptions in essential services and environmental health issues. Using qualitative methods, this ongoing study documents the stressors, responses, and experiences of patients, and providers/organizations involved in the receipt and delivery of gynecologic oncology care in PR, respectively. Methods: We conducted two focus groups (November-December 2018) among women ≥21 years with gynecologic cancer (n=12) and eight key-informant interviews among providers/stakeholders who offer services to these population in PR. Patients’ interviews addressed psychosocial and environmental stressors and multi-level responses experienced by the women in the aftermath of the hurricanes, and concerns regarding their condition. Key-informants’ interviews addressed problems encountered in their clinics/organizations in the aftermath of the hurricanes, perceived stressors and risks of patients, and recommendations for future preparedness efforts. Sessions were audio-recorded and transcribed to identify emergent themes. Results: The focus groups evidence that all patients faced lasting difficulties having a healthy diet and with communication, electricity and water services. Women under the Government Health Plan (GHP) faced longer time without essential services and were less prepared for the hurricanes than those with private health insurance. None received disaster preparedness information from their clinics/physicians and all expressed feeling environmental stressors such as heat, mosquitoes, humidity, noise and air pollution produced by household electric generators. All patients experienced delay in cancer treatment, but women in the GHP had longer delays, as most public hospitals were saturated or inoperable. Key-informants expressed that clinics/organizations did not have an emergency plan in place, services were saturated because the collapse of many facilities, and that some patients decided to interrupt their treatments, and others experienced recurrence. The biggest obstacle was lack of effective communication between the government and the health services, calling for interdependence of systems, but with better communication. Conclusion: Study results are guiding the topics that will be assessed in the subsequent quantitative phase of this NCI sponsored project, and the development of a disaster management plan for cancer patients in PR. Results show that all components of disaster management (planning, preparedness, response and recovery) failed. Disparities in preparedness and healthcare interruption in patients in the GHP could affect patient outcomes. NCI Grant #R21CA239457. Citation Format: Ana P. Ortiz, Mirza Rivera, Sandra I. Garcia-Camacho, William Calo, Guillermo Tortolero-Luna, Sharee Umpierre, Istoni Daluz-Santana, Pablo Mendez. Impact of hurricane-related stressors and responses on oncology care and outcomes of women with gynecologic cancer in Puerto Rico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-157.
Background In September 2017, hurricanes Irma and Maria affected Puerto Rico (PR) and the US Virgin Islands (USVI), causing major disruptions in basic services and health care. This study documented the stressors and experiences of patients with gynecologic cancer receiving oncology care in PR following these hurricanes. Methods We conducted 4 focus groups (December 2018-April 2019) among women aged ≥21 years from PR who were diagnosed with gynecological cancer between September 2016 and September 2018 (n = 24). Using the same eligibility criteria, we also interviewed patients from the USVI (n = 2) who were treated in PR. We also conducted key-informant interviews with oncology care providers and administrators (n = 23) serving gynecologic cancer patients in PR. Discussions were audio-recorded, transcribed verbatim, and coded to identify emergent themes using a constant comparison method. Results Analyses of focus group discussions and interviews allowed us to identify the following emergent themes: 1) disruptions in oncology care were common; 2) communication between oncology providers and patients was challenging before and after the hurricanes hit; 3) patient resilience was key to resume care; and 4) local communities provided much-needed social support and resources. Conclusions This study provides firsthand information about the disruptions in oncology care experienced by and the resiliency of women with gynecologic cancer following hurricanes Irma and Maria. Our findings underscore the need to incorporate oncology care in the preparedness and response plans of communities, health systems, and government agencies to maintain adequate care for cancer patients during and after disasters such as hurricanes.
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