Environmental Stressors Suffered by Women with Gynecological Cancers in the Aftermath of Hurricanes Irma and María in Puerto Rico

Abstract

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.

Disruptions in Oncology Care Confronted by Patients with Gynecologic Cancer Following Hurricanes Irma and Maria in Puerto Rico

“… 30 Equally important, a prior study from our team also identified that, following Hurricane Maria, environmental stressors such as lack of potable water, heat and uncomfortable temperatures, poor air quality, noise pollution from generators, and pests (eg, mosquitos, rats) were top concerns in PR. 24 Future disaster plans should include strategies to mitigate these environmental stressors as they threaten public health and the well-being of populations.…”

“…Additional details about our methodology are available elsewhere, including a report on environmental stressors experienced by gynecologic cancer patients and oncology care providers and administrators. 24 The Institutional Review Board of the University of Puerto Rico Medical Sciences Campus approved the study protocol (#A1810418 approved on August 30, 2018), including the qualitative work involving both gynecologic cancer patients and oncology care providers and administrators.…”

Hurricanes and Anomalous Heat in the Caribbean

“…In the latter study, mortality began to increase at HI thresholds around 31°C, around the values we present in Table 1. Second, uncomfortable temperatures in the aftermath of Hurricane María were among the top concerns of cancer patients and health‐care providers and administrators (Méndez‐Lázaro et al., 2021). Finally, Bobb et al.…”

“…In the latter study, mortality began to increase at HI thresholds around 31°C, around the values we present in Table 1. Second, uncomfortable temperatures in the aftermath of Hurricane María were among the top concerns of cancer patients and health-care providers and administrators (Méndez-Lázaro et al, 2021). Finally, Bobb et al (2014) showed that larger increases in central air conditioning prevalence tended to have slightly larger reductions in heat-related mortality risk over time.…”

“…However, excess mortality has been noted at HI values much lower than this (Burkart et al., 2011). Moreover, HI values in the Caribbean rarely exceed 35°C and, nonetheless, there is evidence that excess mortality occurs under elevated heat conditions (Méndez‐Lázaro et al., 2021) and that heat is a main public health concern (Méndez‐Lázaro, 2015; Méndez‐Lázaro, Muller‐Karger, et al., 2018; Méndez‐Lázaro, Pérez‐Cardona, et al., 2018; Méndez‐Lázaro et al., 2021). Additionally, tropical cyclones can leave society more vulnerable to heat (Kozlov, 2021; Skarha et al., 2021), a risk that is increased by anthropogenic climate change (Feng et al., 2020; Gasparrini & Leone, 2014; Lin, 2019; Matthews et al., 2019).…”