Katrina, Irma, Harvey: How oncology responds to hurricanes

Lung cancer patients who had a hurricane disaster declared during radiotherapy had worse overall survival than those who completed treatment in normal circumstances, with longer disaster declarations associated with increasingly worse survival.

The finding comes from a report by American Cancer Society investigators published in JAMA, which suggests several mitigation strategies, including arranging for transferring treatment and eliminating patient out-of-network insurance charges during disasters.

Natural disasters, such as hurricanes, can interrupt the provision of oncology care. Radiotherapy is particularly vulnerable because it requires dependable electrical power and daily presence of specialized teams and patients for treatment delivery.

Disruptions are especially concerning for patients undergoing treatment for locally advanced NSCLC because treatment delays as little as two days can impact survival.

To learn whether hurricane disasters were associated with poorer survival, investigators from the American Cancer Society and Massachusetts General Hospital led by the ACS’s Leticia Nogueira, compared outcomes for patients undergoing radiotherapy for nonoperative locally advanced NSCLC between 2004 and 2014 from the National Cancer Database that captures approximately 70% of newly diagnosed cancers in the U.S.

Among those, 1,734 patients who had a hurricane disaster declared during radiation treatment were matched with an equal number who were not exposed but had similar characteristics. For the group experiencing a hurricane disaster during treatment, the total number of deaths was 1,408; mean survival time was 29 months; and 5-year survival estimate was 14.5%.

For the unexposed group, the total number of deaths was 1,331; mean survival time was 31 months; and 5-year survival estimate was 15.4%.

A growing body of evidence is pointing to the obvious ways in which climate change impacts the environment. But those of us who study the impact of climate change on health have noted that the long-term shifts in temperatures and weather patterns also have not-so-obvious, downstream health implications, specifically for cancer. 

Here in South Florida, we are at ground zero of the global climate change issue. Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine is in an area that provides a unique opportunity to study and understand how changes occurring in the natural environment influence disease risk and outcomes for all people. 

This includes people in the Miami-Dade County catchment area who may experience compounded effects, because they are already medically underserved and underrepresented.

Stephen Nimer: The Sylvester Comprehensive Cancer Center opened its doors in 1992, which is just when Hurricane Andrew hit. I’ve looked through our archives: There are some great articles in the Miami newspaper, because we remained open and provided care right after Hurricane Andrew, which has been the most devastating hurricane here in, I don’t know exactly how many years, maybe 30 or 50 or whatever.

But even following the more recent hurricanes, we’ve been able to provide care for our patients. After Hurricane Irma, in one of our satellites we were open the next day, and we treated 30 patients with chemotherapy who needed it, even though many folks were without electricity.

It’s a unique challenge. We have hurricane preparedness for our laboratories. We have drills for the hospital. And we have a command center.

During Irma, because I live on Miami Beach, in a mandatory evacuation zone, I had to leave my home for a few days. And so, my wife and I slept in the hospital for three nights. There’s food, water, and air conditioning in the hospital. It’s not a bad place to be! 

Peter WT Pisters: At that time, as you may remember, there was a hurricane out on the gulf that was approaching Texas. I was flying into Austin the day before. I was a little worried about being diverted and thinking about what that would mean in terms of showing up on time for the interview.

As I went into that interview, I did something that was very unusual for me. I opened the interview with a joke. As people come to me every now and then for advice about interviewing, I always tell them, ‘Don’t use humor. You never know, that might really backfire.’

So, what I said to the regents was something like ‘I am delighted to be here, I am really excited to talk about this opportunity. I had fears about being diverted and carrying out this interview on Skype from a Motel 6 in Shreveport.’

The regents laughed, and I did, too.

Oncology organizations and NCI are helping cancer patients and oncologists displaced by Hurricane Katrina.

The American Society of Clinical Oncology is helping to coordinate treatment services. The following resources can be found at www.asco.org/katrina:

• Hurricane Katrina Message Board, searchable by keyword, is a physician/patient locator and communications tool. Messages are welcome from dislocated patients or from health care providers treating hurricane victims who need to consult with those patients’ cancer doctors.
• NCI assistance: Because many displaced patients do not have internet access, ASCO and NCIare collaborating to help connect patients with alternate cancer care providers, using NCI’s toll-free operators who are aided by ASCO’s online resources. Live assistance is available at 1-800-4CANCER.
• List of oncology practices accepting displaced patients: ASCO is maintaining a list of oncology practices in Louisiana, Mississippi, and Texas, as well as in several other states, that have indicated their ability to care for patients in need of urgent treatment during this time. Patients can call the listed doctors’ offices or cancer centers to learn more about receiving treatment while they are unable to access their primary cancer care facilities. 

The American Society for Therapeutic Radiology and Oncology has a list of radiation therapy facilities around the country willing to treat patients who have been evacuated from the area. That list is available at www.astro.org/katrina.htm. 

Getting medical records for these patients will be a challenge, ASTRO officials said. A consortium of providers from the Gulf Coast region have established a call center through the Western Michigan Cancer Center in Kalamazoo, Mich., where displaced oncologists can register. This will allow the new radiation oncologist to talk to the original doctor to ensure that people with cancer continue to receive the proper treatments. That number, 1-800-636-3876. 

For patients enrolled on NCI-sponsored clinical trials, and doctors who are asked to treat cancer patients who have been on an NCI-sponsored trial, NCI has established a phone number, 301-496-5725. 

During the emergency, NCI will send cancer investigational drugs for displaced patients to sites that had not previously participated in trials, assist with sharing of cancer drug supplies, assist with regulatory issues, and provide protocols to physicians caring for cancer trial patients in emergency situations. 

Mark Clanton, NCI deputy director for cancer care delivery systems, is coordinating the NCI efforts. “Our first and foremost concern is the safety and well-being of medical personnel and patients in the area,” Clanton said in a prepared statement. “We are marshalling all available communication and information resources to accomplish this, and are also working to help NIH address the needs of displaced researchers and others.”

Augusto C. Ochoa’s introduction to NCI community research had the feel of a battlefield commission. 

In the aftermath of the 2005 Hurricane Katrina, the PI of what was then the Community Clinical Oncology Program informed Ochoa that she would be leaving Louisiana State University.

At the time, Ochoa, a pediatric immunologist, was building the tumor immunology program at LSU. The departing oncologist brought Ochoa a folder and said, “This is the CCOP. I have just notified the NCI that they should close it, because all oncologists at LSU have left.” 

Ochoa had a question: “What does CCOP stand for?” 

After hearing a brief explanation, Ochoa, a former intramural investigator at NCI, said, “Well, I don’t think we should close it, because this is a lifeline for our patients. It’s also an institutional grant. Who should I talk with at NCI?” 

Ochoa, who had been an intramural researcher at NCI and served on NIH study sections and the NCI Board of Scientific Counsellors, called Worta McCaskill-Stevens, then the NCI chief of the CCOP program, who is now the chief of the Community Oncology and Prevention Trials Research Group.

The two worked out a plan for the LSU-based CCOP to remain open.

Ochoa, the principal investigator of the Gulf South Minority Underserved NCI Community Oncology Research Program, has won the 2022 Harry Hynes Award for Outstanding Contributions to Clinical Trials and Community Research.

CancerCare is offering direct financial assistance to cancer patients residing in the U.S., including Puerto Rico and the U.S. Virgin Islands, who have been impacted by Hurricanes Harvey, Irma, Jose, or Maria.

Many cancer patients and their families are grappling with the trauma of uncertainty, temporary relocation, loss of medication, and property damage, in addition to coping with the challenges of their cancer diagnosis and treatment.

To support those in need, CancerCare is providing:

• Financial assistance to cancer patients in active treatment who have been affected by Hurricanes Harvey, Irma, Jose or Maria. Grants will be distributed via check, and can be used to help offset the costs of medical bills, homecare, childcare, transportation, general household bills, lodging, and other treatment-related expenses. The application requires that a patient’s oncology care provider verify the patient’s treatment status and location.
• Resource referrals to help people coping with cancer in the midst of a natural disaster find resources to help address the needs that have arisen as a result of a hurricane’s impact.
• Emotional support with one of CancerCare’s oncology social workers, who provide emotional support to people coping with cancer, their caregivers, and their loved ones.
• Educational information to help patients and families anticipate and manage the emotional and logistical challenges of living with cancer in the midst of a hurricane and its aftermath.

CancerCare has raised nearly $665,000 since September 2017 to provide direct financial assistance for people with cancer who have been impacted by hurricanes.

The majority of this support has been allocated to people with cancer in Puerto Rico, many of whom are struggling to access treatment while lacking basic necessities like power and clean water. Support has also been provided to Puerto Rican residents who relocated to the continental United States after Hurricane Maria.

In Puerto Rico, funds were distributed in partnership with more than 100 local oncology providers. CancerCare also partnered with a local medical transportation company, which has provided 954 rides to and from oncology practices to date.