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 Cancer patients undergoing radiation therapy particularly vulnerable
in disasters because they need reliable electricity for daily
treatments, researchers note in JAMA. Previous research has linked
even brief interruptions in daily radiation with worse survival.
The current study focused on patients with non-small cell lung
cancer, the most common form. Researchers followed 1,734 patients
whose radiation therapy was disrupted by a hurricane sometime
between 2004 and 2014 and compared them to 1,734 similar patients
who had uninterrupted treatment.
When hurricanes interrupted radiation, patients survived an average
of 29 months after their diagnosis, compared with 31 months for
people without disruptions.
"This is the first study to empirically evaluate the impact of
natural disasters on cancer survival," said Leticia Nogueira, lead
author of the study and a researcher at the American Cancer Society
in Atlanta.
Survival odds were long for everyone in the study.
Researchers followed half of the patients for at least 15 months.
During the study, 1,408 patients with treatment interrupted by
hurricanes died, as did 1,331 patients who were unaffected by
natural disasters.
Five-year survival rates were 14.5% for patients whose radiation got
interrupted during hurricanes and 15.4% for other patients in the
study, researchers estimated.
Overall, patients were 19% more likely to die during the study when
radiation got disrupted by hurricanes than when treatment continued
uninterrupted.
The disaster declarations for hurricanes during the study lasted
from 1 to 69 days. The risk of death during the study increased with
the length of disaster declarations, rising to 27% for disasters
lasting 27 days.
The study wasn't designed to prove whether or how hurricanes
directly impact survival with lung cancer. Another limitation is
that searchers lacked data on factors that might independently
impact survival outcomes including patients' smoking history,
treatment side effects, and the reasons for or exact dates of
treatment breaks.
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Still, the differences in survival outcomes can and should be
prevented, the study team writes.
"Hurricanes can be predicted and cancer patients should be included
in disaster mitigation planning," Nogueira said by email.
"Patients undergoing daily radiation treatment should be identified
before a hurricane disaster, treatment should be transferred to a
different facility, and insurance out-of-network charges should be
eliminated," Nogueira added.
When hurricane warnings come, patients who haven't started radiation
should, when possible, start care at a facility outside of the
hurricane's path, said Dr. Richard Cassidy, a radiation oncologist
with Cancer Specialists of North Florida in Jacksonville. And
patients already in treatment should have their care transferred.
"Physicians and other medical personnel must be accommodating in
crises and expedite any radiation planning and other factors to
ensure as minimal delay of care as feasible," Cassidy, who wasn't
involved in the study, said by email. "Working in a community cancer
center in an area prone to hurricane impact, we are constantly
refining and planning for contingencies in the event of a disaster
that leads to an extended loss of power or ability of our
radiotherapy clinics to operate."
As extreme weather becomes more common, this type of planning takes
on new urgency, said Asal Johnson, a public health research at
Stetson University in DeLand, Florida, who wasn't involved in the
study.
"The impacts of climate change and related extreme weather events
extend to cancer patients with possible serious consequences,"
Johnson said by email. "It is important for cancer treatment
facilities to have a system in place during hurricane seasons and
communicate to patients what could be done if the facility is forced
to close down."
SOURCE: http://bit.ly/2kdYApN JAMA, online July 16, 2019.
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