As Hurricane Ian approached Florida and meteorologists predicted landfall near the Tampa Bay area, cancer hospitals in the area prepared for the worst—a direct hit by a Category 4 storm.
Source: Tampa General Hospital
On Sept. 28, Tampa breathed a collective sigh of relief. The storm had changed course, making landfall further south, in Cayo Costa, near Fort Myers.
“We are going to be between moderate to minimal damage, given the changes in Ian’s projected trajectory,” Eduardo M. Sotomayor, director of the cancer institute at Tampa General Hospital, said to The Cancer Letter. “Reopening by Friday means that for patients with chemotherapy infusions that were canceled on Tuesday, Wednesday, Thursday—we need to call them. Especially those patients that need to be treated right away.”
Cancer clinics located further south took the full brunt of Ian—from Sarasota to Naples, where the eyewall of the hurricane came ashore and storm surge inundated entire cities.
Florida Cancer Specialists, a network of nearly 100 community practices, is assessing the extent of damage.
“Given the violent pace and severity of this storm, elevated water levels and debris are a real concern,” FCS CEO Nathan H. Walcker said to The Cancer Letter. “While many clinics may open again as soon as tomorrow, others, particularly in Southwest Florida, may take longer given the level of damage sustained.
“We are focused on ensuring the safety of our team, while also prioritizing recovery and operations to best serve our patients within their communities.”
Tampa General Hospital closed its outpatient clinics Sept. 28 and Sept. 29. H. Lee Moffitt Cancer Center & Research Institute closed its outpatient clinics through Sept. 30.
“Knowing that the outpatient services would be disrupted, we did make efforts to shift many of those appointments to virtual visits,” Sabi Singh, executive vice president and chief operating officer of Moffitt Cancer Center, said to The Cancer Letter. “At the same time, with cancer patients, there is an urgent need to undergo treatments and procedures so coordinating with them and addressing those issues as soon as possible is our number one priority.
“During the storm, it’s inpatients that are in the hospital, more acute patients that are our focus—just making sure that our team A (Active response team) and team B (Relief team) staff are taking care of them, and we are providing that care safely to our patients,” Singh said.
As the storm approached the coast, it first appeared that Tampa was on the direct path for the Category 4 hurricane. Teams at both cancer hospitals prepared for the worst possible outcome, but Tampa General Hospital, located on coastal Davis Islands, was in a more precarious situation.
The hospital erected a flood barrier, called the AquaFence.
Source: Tampa General Hospital
“Worst case scenario for us, if this is bad, we’ve probably got the whole first floor of the hospital, maybe two floors, completely underwater,” Sotomayor said. “Our radiation therapy machines, all of our infusion tools, our pharmacy will be underwater. We could not use that service for weeks. If that happens, what do we do?”
Sotomayor met with leadership in his health system every day this week to discuss how they’d respond to a potential storm surge:
“We would transfer patient care and outpatient infusion in an inland area,” Sotomayor said. “It would disrupt care significantly. Fortunately, for a hurricane, you have five to seven days to prepare to go through different scenarios.”
Nearly 12 miles inland from Tampa General, leadership at Moffitt had similar conversations. Moffitt, like Tampa General, made the decision to split cancer care staff and faculty into two teams, Team A, the immediate response team, and Team B, the recovery team.
“As a healthcare organization, we always have to be prepared in terms of evacuation—but those decisions are made real time,” Singh said. “We’re prepared for any kind of emergency… That exercise happens well in advance at the start of every year. Who are our response teams and what are their needs? Do they have any kids? Do we need to make sure that we take care of the kids while they are here?
“If you are in a lockdown situation that can last up to two or three days, we have systems in place in terms of food availability, meeting any dietary restrictions, availability of overnight accommodations for staff and their children. Those kinds of preparations go a long way,” Singh said.
On the eastern side of Florida, Sylvester Comprehensive Cancer Center was prepared to accept patients from the areas hit hardest by the storm. It coordinated with Disaster Aid Services to Hospitals, or DASH, a mutual aid agreement between hospitals all over Florida.
“One of the important things that we did earlier this week was reach out to our DASH partners,” Vincent Jesus Torres, Emergency Management Director at University of Miami Health System and Miller School of Medicine, which includes Sylvester Comprehensive Cancer Center, said to The Cancer Letter. “We also reached out to hospitals of which we have a reciprocal transfer agreement, namely Moffitt Cancer Center. We reached out to our colleagues at Moffitt and offered any assistance that they may need. We’ve been in constant communication with them.”
Hurricanes, wildfires, and ice storms exacerbated by climate change will have an outsized effect on cancer care. “Health systems, including cancer centers, should find ways to promote collaboration and action,” experts from Sylvester wrote in a guest editorial (The Cancer Letter, July 29, 2022). “Hopefully, it’s not too little, too late. Addressing and limiting the impact of climate change on health will require great minds, lots of quality research, and collaboration.”
Moffitt has developed contingency plans in case of emergencies with the Florida Hospital Association as well as nearby hospitals, Singh said.
“We are in communication with other state agencies, because they are so helpful at that time to remove any kind of challenges or barriers, and provide any kind of help,” he said. “Because of that close communication and making those decisions in case—let’s say, it’s an evacuation or some other drastic measures we have to take—those go really well.”
As the hurricane moves inland, patients in the rural communities of central Florida are more at risk, Sotomayor said.
“It is going to affect several areas, poorer communities that are part of our catchment areas,” Sotomayor said. “We are not only going to assess the impact in our hospital that at this point is minimum to moderate, but we are also going to be assessing the impact of the hurricane in this new path, Central Florida, which has a lot of rural communities.”
Partnerships with community oncology groups are key to helping these patients, Sotomayor said.
“This partnership with the community oncologists, Florida Cancer Specialists, would allow us to rapidly provide the best care to patients after the hurricane,” he said. “If there are cancer patients who need to be treated but local oncologists cannot provide the care, those patients will be coming to us and we are ready to help.”
FCS is directing patients to nearby network locations and utilizing telehealth to provide continuing care (The Cancer Letter, July 17, 2020).
“As a Florida-based practice dealing with hurricane season comes with the territory—it’s like clockwork,” FCS’s Walcker said. “That said, we’ve been laser-focused this past year on really dialing in our crisis management and hurricane preparation by re-visiting standard operating procedures, drilling, and preparing for any range of events or outcomes. We take care of a highly acute, medically vulnerable population and so a team-based approach that puts patients first is our main priority. The support we’ve received has been robust, and appreciated, though there is plenty of work left in front of us as we look to rebuild.
“This storm was the real deal and put all of that work to the test. Given our statewide footprint, and the inherent complexity of community oncology care with all that goes with it from drug inventory management, courier services, specimens, labs, staffing, and beyond, there is a lot to manage. Much as we did during the peak phases of COVID over the last couple of years, we will utilize telehealth as a means of delivering patient care, in instances where patients cannot come into a clinic setting.”
The telehealth infrastructure developed during the COVID-19 pandemic will aid in rescheduling patient appointments, Sotomayor said.
“On Friday, members of our team will be doing a lot of telehealth,” he said. “It’s not only about us reopening, it’s also about the flooding and blocked roads in some areas. Trees are going to be down. Some patients will not be able to access or drive 30 minutes or one hour to come to see us. Now we have telehealth.”
Members of the oncology care team at Moffitt and Tampa General are working to reschedule canceled appointments.
“We have a very elaborate structure in place with our call center, our care teams that communicate individually with each patient to let them know where we are right now in terms of our outpatient, and then coordinating their next visit,” Singh said. “That arrangement and system that we have in place works very well.”
FCS leaders are deploying their care management teams to triage and provide the appropriate level of care coordination as recovery efforts are underway.
“Our team had been tracking the storm well in advance, and meeting regularly to run through our game plan,” Walcker said. “At the end of the day, there is only so much you can plan and prep for, before going into reading and react mode. We’ve been nimble and assessing/triaging issues quite well to best manage patient communications, scheduling, and the logistical gymnastics of shifting medications to safe, secure locations.
“I am incredibly proud of our entire team for answering the call and stepping up to lead in this time of crisis.”
Matthew Bin Han Ong contributed to this story.
