The effect of natural disasters on cancer care: a systematic review

Identifying communities where older adults with major cancer diagnoses are contending with high levels of natural hazards

PURPOSE

We aimed to identify geographical areas of vulnerability, namely co-occurring heightened cancer prevalence and exposure to natural hazards.

METHODS

Cancer prevalence data for four major cancers (lung, breast, colorectal, and prostate) from the Centers for Medicare and Medicaid Services were used along with National Risk Index (NRI) for 18 hazards, including hurricane and wildfire, from the Federal Emergency Management Agency. We examined county-level spatial correlations between cancer prevalence and NRI values using Lee's L statistics.

RESULTS

NRI values and cancer prevalence were positively correlated with substantial variations (global Lee's L = 0.24, p < 0.05; local Lee's L IQR -0.07 to 0.38). Out of 3106 counties in the contiguous United States, 455 (14.6%) had statistically significant spatial correlations between NRI values and cancer prevalence, of which 194 (43%) were hotspot counties with high NRI values correlated with high cancer prevalence. These hotspot counties were located mostly along coastlines, specifically the Atlantic and Gulf of Mexico with some pockets in the Midwest, primarily in urban areas (151, 77.8%), and within the catchment areas of National Cancer Institute-designated cancer centers (173, 89.2%). They also differed in the types of natural hazard and cancer, as well as community resilience and social vulnerability.

CONCLUSIONS

We identified several geographical areas in the United States with increased need, which may serve as priority areas for future research around the impacts of environmental exposures on cancer continuum. On a public health level, they also may guide prioritization efforts for environmental hazard planning and preparation.

Building climate resilience and mitigating the impact of climate change on cancer care: strategies and solutions for low and middle income countries

Climate change poses an enormous threat to human health. It increases exposure to risk factors related to cancer while simultaneously threatening effective cancer care in the face of overstrained resources and natural hazards. Low and middle income countries (LMICs) are disproportionately affected by the effects of climate change which further limits their ability to respond effectively to this growing threat. Measures to build resilience and mitigate the impact warrant multi-sectoral local and global collaborations. Mitigation strategies positively impact cancer control by reducing exposure to risk factors. The current pace of climate change and the rising rates of cancer incidence in LMICs calls for urgent, effective, evidence-based global efforts toward protecting the health and wellbeing of our planet. This paper discusses strategies to build climate resilience in healthcare and measures to mitigate the emissions of oncology care in LMICs.

Impact of Environmental Determinants of Health on Access to Surgical Care

Environmental determinants significantly impact the health of individuals and populations contributing to increased rates of traumatic injuries, higher cancer incidence, and disruptions in access to healthcare systems and surgical services. Additionally, the healthcare industry contributes significantly to climate change, negatively impacting the earth's environment in both developed and developing nations. Natural disasters such as hurricanes and wildfires cause destruction of hospitals, clinics, pharmacies, and even supply chain facilities, hindering patient access to surgical care. These impacts were recently evidenced by the recent hurricanes Helene and Milton, which struck the Southeast US, hindering access and delivery of surgical care. Damage to infrastructure caused by hurricanes can compromise emergency response efforts, limiting access to essential services, and interrupting healthcare delivery. The increase in traumatic injuries because of natural disasters, coupled with damage to infrastructure, places an additional strain on healthcare systems' ability to provide essential and critical care. While the direct immediate effects of natural disasters and other environmental determinants can be substantial, a decrease in regular and consistent access to healthcare can lead to a long-term decline in community health. Continuous evaluation of cultural and environmental factors that impact the health care system's capacity to provide care is necessary to inform interventions to improve the health system's ability to adapt to provide continued access to care and serve the surgical community.

The Impact of Climate Change on Cancer Surgery and Healthcare Delivery: A Review of Environmental and Surgical Challenges

PURPOSE

More than 10 million annual global cancer deaths are exacerbated by the impact of climate change and environmental determinants of health. This brief report provides a summary of and mitigating recommendations for the complex intersection between climate change and surgical cancer care.

METHODS

A review of scientific literature from the last 10 years was conducted to assess the current impact of climate change on cancer care with a focus on surgical interventions. Studies with an impact score of 6 or higher and the keywords of climate change, extreme weather, cancer care, and surgery were reviewed. After removing duplicates and excluded studies, 30 studies remained and were reviewed by two reviewers.

RESULTS

Climate-related factors impacting surgical care result in a myriad of healthcare impacts, including disruption of services, impact on patient outcomes and survival, as well as an overburdening of hospital and surgical services.

CONCLUSION

Climate change, including extreme weather events, threatens cancer surgical care and delivery by exacerbating comorbidities, disrupting healthcare systems, and increasing disparities in cancer care. Climate change is a burgeoning threat to global health, cancer care, patients, and communities.

Estimated carbon emissions and support cost savings to telemedicine for patients with tracheal diseases

OBJECTIVE

The patient's journey to the medical center for an outpatient visit can often mean hours of travel in their vehicle, leading to increased expenses and greater carbon dioxide (CO2) emissions into the environment. The study demonstrates the estimated carbon emission and cost savings associated with a telemedicine program dedicated to patients with tracheal disease in the Brazilian public health system.

METHODS

Cross-sectional study of telemedicine visits for patients with tracheal disease referred to a public academic hospital between August 1, 2020, and December 30, 2023. The consultations occurred in a telemedicine department using the hospital's proprietary platform. The analysis included the round-trip distance savings using home postal codes; CO2 emissions savings by transportation using the Greenhouse Gas Protocol (GHG Protocol) adapted to the Brazilian reality ("Programa Brasileiro GHG Protocol"); and the cost savings in transportation and support using the Brazil Ministry of Health program.

RESULTS

1767 telemedicine visits with 680 patients were conducted, 363 (53.4 %) male and 317 (46.6 %) female, a median [IQR] age of 33 [12.0-51.0] years. Patients were from 170 Brazilian cities from 22 states. There were 2.219.544,3 round-trip kilometers saved (median per patient [IQR] 542,88km [190,36-2.672,6]), corresponding to an estimated 353.097,55kg of CO2 emissions savings (median per patient [IQR] 102,56kg [36,56-496,96]). The cost savings was 305.187,96 dollars (median per patient [IQR] $48,22 [24,97-162,51] dollars).

CONCLUSION

Telemedicine consultations, in addition to significantly reducing carbon emissions and costs, promote greater accessibility and sustainability in medical care. These findings may influence public policies to expand telemedicine programs, especially in remote regions, and strengthen environmental initiatives in healthcare.

Climate change and tuberculosis: an analytical framework

Climate change is likely to exacerbate a range of determinants which drive tuberculosis, the world's leading infectious disease killer. However, tuberculosis is often neglected in wider climate health discussions. Commissioned by the World Health Organization, we developed an analytical framework outlining potential causal relationships between climate change and tuberculosis. We drew on existing knowledge of tuberculosis determinants, identified which are likely to be sensitive to the effects of climate change, and conceptualised the mechanistic pathways through which this might occur. We collated evidence for these pathways through literature reviews. Our reviews found no studies directly linking climate change and tuberculosis, warranting research to build evidence for action. The available evidence supports the existence of plausible links between climate change and tuberculosis, and highlights the need to include tuberculosis in climate risk adaptation and mitigation programmes, and climate-resilient funding and response mechanisms. Further evidence is urgently needed to quantify the effects of climate change on tuberculosis.

Features of causes of indirect certified disaster-related death in areas affected by the Fukushima Daiichi nuclear power plant accident: an observational study

OBJECTIVES

To investigate the details of disaster-related deaths due to the indirect health effects of the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident following the Great East-Japan Earthquake in 2011 and serve as a source of reference in the event of similar circumstances in the future.

DESIGN

A retrospective observational study.

SETTING

Minamisoma City, Fukushima Prefecture, Japan, which is located 13-38 km north of the FDNPP.

PARTICIPANTS

520 residents of Minamisoma City, Fukushima Prefecture, who were certified as having died from disaster-related causes between September 2011 and February 2021.

RESULTS

The most common cause of death was circulatory system diseases (27.7%), followed by respiratory system diseases (25.0%) and neoplasms (15.4%). The prevalence of circulatory and respiratory diseases is higher in older people, suggesting that they are more susceptible to indirect health effects due to the environmental changes related to evacuation. Malignant neoplasms accounted for the third and leading cause of death overall and for people in their 50s, respectively, implying the potential impact of evacuation on cancer diagnosis and treatment. Suicide is the leading cause of death among younger people and can occur even long after a disaster, which shows the psychological impact of environmental changes.

CONCLUSION

To prevent indirect disaster-related deaths in the future, it is important to consider appropriate intervention methods by age group and period since disaster occurrence. It is especially important to improve the environment of evacuation shelters and establish a healthcare system for evacuees, create a system for cancer screening and treatment during evacuation and expand long-term suicide prevention measures.

Climate change, climate disasters and oncology care: a descriptive global survey of oncology healthcare professionals

PURPOSE

Climate disasters and climate change have implications for healthcare globally. As the number and intensity of climate disasters increase, it is important to understand the effects on healthcare. We conducted a global survey of oncology healthcare providers to identify awareness, experiences, and educational needs related to climate change.

METHODS

An existing climate and health survey was adapted to oncology. This IRB- approved, 30-item survey measured demographics, climate disaster awareness, effects on cancer care and educational needs. Healthcare professionals employed in oncology settings (practice, research, or academic) were eligible. The survey was disseminated via social media and professional organizations. Descriptive statistics were computed using SPSS.

RESULTS

154 responses from 26 countries were received from nurses (56%), physicians (19%), and other healthcare professionals (25%). Common climate change-related events impacting oncology care were extreme heat (63.8%) and heavy rains (52.2%). Respondents reported their workplace has a disaster plan for climate-related weather events (50.4%) or has taken steps to prepare for a climate-related weather event (48.5%). Respondents were aware that the planet has warmed significantly (98.7%), that healthcare contributes to greenhouse gas emissions (98.6%) and reported wanting to learn more about how climate change affects cancer care (88.3%). Preferred educational modalities include webinars (69%), e-learning (55%), journal articles (48.3%), conferences (46.3%) and podcasts (38.9%).

CONCLUSIONS

This global survey is the first to identify the awareness, experiences, and educational needs of oncology healthcare professionals related to climate change and climate disasters. Healthcare providers are positioned to take leadership roles related to climate and health.

Cancer Care After Türkiye-Syrian Earthquakes: A Qualitative Study

OBJECTIVES

In the field of cancer, many cancer patient associations (CPAs) have been established in Türkiye to support individuals living with cancer (ILCs) throughout the diagnosis and treatment processes. The presence of CPAs for ILCs became more significant after the major earthquakes in southeastern Türkiye in February 2023. The aim of this study is to identify the challenges of ILCs after the earthquakes from the perspective of CPA members.

METHODS

This study employed a qualitative approach. The data collection method was in-depth interviews. Semi-structured, open-ended interviews were conducted with 15 volunteers who work with ILCs, selected through purposeful sampling. The data were analyzed by using inductive thematic analysis. This study was conducted between April and May 2023.

RESULTS

Three main themes (problems of ILCs caused by earthquakes, access to health care, future concerns) and 11 subthemes were extracted through analyzing interviews.

CONCLUSION

ILCs experienced diverse difficulties after earthquakes. Members of CPAs observed that acute interventions to injured people and humanitarian aid activities had the first-place importance after the earthquake, while cancer-related care took the second place, anticipating devastating outcomes for the future of their care. CPAs should be supported by the public, local governments, and central government in their endeavors for ILCs.

Cancer Treatment Disruption by Residence Region in the Aftermath of Hurricanes Irma and María in Puerto Rico

Since 2017, Puerto Rico has faced environmental, economic, and political crises, leading to the emigration of healthcare workers and weakening the healthcare system. These challenges have affected cancer treatment continuity, exacerbating healthcare access challenges island-wide. In this study, we estimate the effect of the residence region on cancer treatment disruption following Hurricanes Irma and María (2017). Telephone surveys were conducted with 241 breast and colorectal cancer patients aged 40 and older who were diagnosed within six months before the hurricanes and were receiving treatment at the time of the hurricanes. Treatment disruption was defined as any pause in surgery, chemotherapy, radiotherapy, or oral treatment due to the hurricanes. Prevalence ratios (PRs) of treatment disruption by residence region were estimated using the San Juan Metropolitan Area (SJMA) as the reference. Fifty-nine percent of respondents reported treatment disruption; among them, half experienced disruptions lasting more than 30 days, with 14% of these enduring disruptions longer than 90 days. Adjusted models showed a 48% higher prevalence of disruption outside the SJMA (PR = 1.48, 95% CI: 1.06-2.07). Specific geographic regions (Arecibo, Bayamón, Caguas, and Mayagüez) exhibited higher disruption prevalence. These findings emphasize the need for disaster preparedness strategies that ensure equitable healthcare access for all cancer patients following environmental calamities.

Hispanic Cancer Survivors Exposed to Multiple Natural Disasters: Pre-Post-Disaster Changes in Anxiety, Depression, PTSD, Perceived Stress, and Physical Symptom Burden

BACKGROUND

Studies evaluating the effects of natural disasters on cancer outcomes are scarce, especially among USA ethnic minority groups, and none have focused on the effects of concurrent natural disasters and the COVID-19 pandemic. The goal of this secondary data analysis is to explore the impact of concurrent exposure to COVID-19 and earthquakes on psychological distress and symptom burden among Puerto Rican cancer survivors.

METHODS

This secondary data analysis (n = 101) was part of a longitudinal case-control cohort study (n = 402) aimed at describing unmet psychological needs among Puerto Rican cancer patients and non-cancer subjects previously exposed to Hurricane María in 2017. The research team pooled data from participants (cancer survivors and non-cancer group) from their baseline assessments and from follow-up assessments conducted during January-July 2020 (earthquake and the lockdown period). A descriptive, paired t-test, non-parametric mean rank test, and two-sided Pearson correlation analyses were performed.

RESULTS

Psychological distress and cancer symptom burden diminished over time. Resilience was significantly correlated with all the psychological and symptom burden variables during both pre- and post-earthquake and COVID-19 assessment periods.

CONCLUSIONS

The results support the role of resilience, social support, and post-traumatic growth as potential protective factors preventing psychological distress and diminishing cancer symptom burden among cancer survivors exposed to natural disasters and the COVID-19 pandemic.

Effect of the 2024 Noto Peninsula earthquake on outpatient chemotherapy among cancer survivors in Japan: a retrospective study

BACKGROUND

The study aim was to elucidate the effect of the 2024 Noto Peninsula earthquake on outpatient chemotherapy treatment of cancer survivors at Kanazawa Medical University Hospital (KMUH), Japan.

METHODS

Medical and nursing records for January 4-31, 2024, from KMUH were retrospectively collected, and data for 286 participants were analyzed.

RESULTS

Of the 286 participants, 95.1% were able to attend their first scheduled appointment. Of the 12 (4.2%) who could not attend because of the earthquake, 7 (58.3%) rescheduled their appointments. A total of 8 participants (2.8%) were unable to attend their second scheduled appointment in January, despite being able to attend their first appointment; 3 (37.5%) of these participants reported that they were unable to attend their appointments because of the effect of the earthquake. Chemotherapy was not administered to 53 (18.5%) participants who did attend, mainly owing to neutropenia, progressive disease, rash, and anemia. Evacuation information was available for 25 participants (8.7%); of these, 8 (28.6%) evacuated to their homes, 7 (25.0%) to public shelters, and 4 (14.3%) to apartments near the hospital. Disaster status information was obtained from 62 participants (21.7%), and indicated experiences such as home damage, water outages, and relying on transportation assistance from family to attend appointments.

CONCLUSIONS

Most cancer survivors receiving chemotherapy at KMUH were able to maintain outpatient visits. However, a few could not attend because of the earthquake. Further studies are needed to provide more detailed information on the effect of disasters on cancer survivors and the potential factors underlying non-attendance at medical appointments.

Inequities in the Impacts of Hurricanes and Other Extreme Weather Events for Cancer Survivors

In this minireview, we examine the impacts of hurricanes and other extreme weather events on cancer survivors, focusing on structural and social determinants of health. We briefly explore influences on biological, psychosocial, and behavioral outcomes and discuss risk and resilience factors in cancer survivorship during and after hurricanes. Our goal is to inform future directions for research that can identify areas in which we can most efficiently improve cancer outcomes and inform changes in health systems, clinical practice, and public health policies. This timely minireview provides researchers and clinicians with an overview of challenges and opportunities for improving disaster preparedness and response for cancer survivors.

Impact of Severe Winter Weather on Operations of a Radiation Oncology Department

Purpose

During winter 2022, western New York faced 2 major storms with blizzard conditions and record-breaking snowfall. The severe weather resulted in power outages and travel bans. This study investigates the impact of these conditions on patient adherence to radiation therapy. Combining data from a large academic center and its satellite clinic, this single-center study sheds light on the challenges faced by cancer care facilities during severe weather and proposes suggestions to prevent and mitigate harm done by severe weather.

Methods and Materials

In this study, data were collected using the MOSAIQ Record and Verify system (v. 2.81) to generate deidentified reports of scheduled and treated patients. The treatment adherence rate was calculated by dividing the number of patients treated by the total number of patients scheduled. Data were specifically collected for patients undergoing treatment on linear accelerators at a primary academic center and a satellite facility. The study focused on working days from November 1, 2022, to March 31, 2023, excluding weekends and holidays (as treatments are not routinely scheduled). Severe weather days were identified using advisories from the National Weather Service and the local institution, including specific periods in November, December, and January.

Results

In the study, 15,010 scheduled treatment visits were recorded across the academic center and the satellite clinic. The mean daily treatment adherence rate was 91.7%. Severe weather conditions led to a significant reduction in adherence, with rates dropping to 77.8%. Adherence rates during nonsevere weather days were notably higher at 93.9%. Statistical analysis confirmed the substantial influence of severe weather on adherence (P < .001). Severe weather had a more pronounced impact on the satellite clinic during periods of severe weather, with absolute reduction in adherence rates of 21.9% versus 15% in the primary hospital. Moreover, adherence at the satellite clinic was lower than at the primary hospital site even under standard operating conditions (92.2% vs 94.0%, P < .001).

Conclusion

As a part of operational planning, it is important to be aware how severe weather can impact treatment adherence. Study findings underscore the importance of proactive measures to ensure patient access to health care services during adverse weather events and highlight the broader significance of incorporating consideration of social determinants of health into contingency planning for maintaining treatment continuity.

Floods and cause-specific mortality in the UK: a nested case-control study

BACKGROUND

Floods are the most frequent weather-related disaster, causing significant health impacts worldwide. Limited studies have examined the long-term consequences of flooding exposure.

METHODS

Flood data were retrieved from the Dartmouth Flood Observatory and linked with health data from 499,487 UK Biobank participants. To calculate the annual cumulative flooding exposure, we multiplied the duration and severity of each flood event and then summed these values for each year. We conducted a nested case-control analysis to evaluate the long-term effect of flooding exposure on all-cause and cause-specific mortality. Each case was matched with eight controls. Flooding exposure was modelled using a distributed lag non-linear model to capture its nonlinear and lagged effects.

RESULTS

The risk of all-cause mortality increased by 6.7% (odds ratio (OR): 1.067, 95% confidence interval (CI): 1.063-1.071) for every unit increase in flood index after confounders had been controlled for. The mortality risk from neurological and mental diseases was negligible in the current year, but strongest in the lag years 3 and 4. By contrast, the risk of mortality from suicide was the strongest in the current year (OR: 1.018, 95% CI: 1.008-1.028), and attenuated to lag year 5. Participants with higher levels of education and household income had a higher estimated risk of death from most causes whereas the risk of suicide-related mortality was higher among participants who were obese, had lower household income, engaged in less physical activity, were non-moderate alcohol consumers, and those living in more deprived areas.

CONCLUSIONS

Long-term exposure to floods is associated with an increased risk of mortality. The health consequences of flooding exposure would vary across different periods after the event, with different profiles of vulnerable populations identified for different causes of death. These findings contribute to a better understanding of the long-term impacts of flooding exposure.

Protecting Caribbean patients diagnosed with cancer from compounding disasters

Caribbean small island developing states are becoming increasingly vulnerable to compounding disasters, prominently featuring climate-related hazards and pandemic diseases, which exacerbate existing barriers to cancer control in the region. We describe the complexities of cancer prevention and control efforts throughout the Caribbean small island developing states, including the unique challenges of people diagnosed with cancer in the region. We highlight potential solutions and strategies that concurrently address disaster adaptation and cancer control. Because Caribbean small island developing states are affected first and worst by the hazards of compounding disasters, the innovative solutions developed in the region are relevant for climate mitigation, disaster adaptation, and cancer control efforts globally. In the age of complex and cascading disaster scenarios, developing strategies to mitigate their effect on the cancer control continuum, and protecting the health and safety of people diagnosed with cancer from extreme events become increasingly urgent. The equitable development of such strategies relies on collaborative efforts among professionals whose diverse expertise from complementary fields infuses the local community perspective while focusing on implementing solutions.

Effects of Wildfire Events on California Radiation Oncology Clinics and Patients

Purpose

The effect of climate-driven events, such as wildfires, on health care delivery and cancer care is a growing concern. Patients with cancer undergoing radiation therapy are particularly vulnerable to treatment interruptions, which have a direct effect on survival. We report the results of a study characterizing the effect of wildfires on radiation oncology clinics and their patients.

Methods and Materials

A survey of California radiation oncologists was used to evaluate emergency preparedness and the effect of wildfires on the delivery of radiation therapy services between 2017 and 2022. Descriptive statistics and Pearson's χ2 tests were performed to investigate potential relationships between provider characteristics, practice settings, and perceptions of the effect of wildfire events. California Department of Forestry and Fire Protection data were employed to map the geographic distribution of wildfires to clinic locations.

Results

Response rate was 12.3% (51/415 radiation oncologists), representing 25% of clinics (43/176) in 41% (24/58) of California counties. Sixty-one percent (31/51) of respondents reported being affected by a wildfire, 2 of which are rural clinics (100%, 2/2) and 29 are (59%, 29/49) metropolitan practices. Of these, 18% (9/51) reported a clinic closure, and 29% (15/51) reported staffing shortages. Respondents reported effects on patients, including having to evacuate (55%, 28/51), cancel/reschedule treatments (53%, 27/51), and experiencing physical, mental, or financial hardship due to wildfires (45%, 23/51). Respondents described effects on clinical operations, including being forced to transfer patients (24%, 12/51), transportation interruptions (37%, 19/51), regional/community evacuations (35%, 18/51), and physical/mental health effects (27%, 14/51) on clinic personnel. Less than half of the respondents (47%, 24/51) reported their workplace had a wildfire emergency preparedness plan. Additionally, geographic analysis revealed that 100% (176/176) of clinics were located within 25 miles of a wildfire.

Conclusions

This study highlights the effects of wildfires on radiation oncology clinics and patients and underscores the need for emergency preparedness planning to minimize the consequences of such disasters.

The Impact of Climate Change on Global Oncology

Climate change is the greatest threat to human health of our time, with significant implications for global cancer control efforts. The changing frequency and behavior of climate-driven extreme weather events results in more frequent and increasingly unanticipated disruptions in access to cancer care. Given the significant threat that climate change poses to cancer control efforts, oncology professionals should champion initiatives that help protect the health and safety of patients with cancer, such as enhancing emergency preparedness and response efforts and reducing emissions from our own professional activities, which has health cobenefits for the entire population.

Climate change and cancer: the Environmental Justice perspective

Despite advances in cancer control-prevention, screening, diagnosis, treatment, and survivorship-racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population.

Protecting vulnerable patient populations from climate hazards: the role of the nation's cancer centers

Individuals diagnosed with cancer are a vulnerable population during disasters. Emergency preparedness efforts are crucial for meeting the health and safety needs of patients, health-care professionals, health-care facilities, and communities before, during, and after a disaster. Recognizing the importance of advancing emergency preparedness expertise to cancer control efforts nationwide, especially in the era of climate change, we searched National Cancer Institute-designated cancer centers' websites to examine emergency preparedness information sharing and evidence of research efforts focused on disaster preparedness. Of 71 centers, 56 (78.9%) presented some emergency preparedness information, and 36 (50.7%) presented information specific to individuals diagnosed with cancer. Only 17 (23.9%) centers provided emergency preparedness information for climate-driven disasters. Informed by these data, this commentary describes an opportunity for cancer centers to lead knowledge advancement on an important aspect of climate change adaptation: disaster preparedness.

Evaluating the Environmental Impact of Radiation Therapy Using Life Cycle Assessments: A Critical Review

Concurrent increases in global cancer burden and the climate crisis pose an unprecedented threat to public health and human well-being. Today, the health care sector greatly contributes to greenhouse gas emissions, with the future demand for health care services expected to rise. Life cycle assessment (LCA) is an internationally standardized tool that analyzes the inputs and outputs of products, processes, and systems to quantify associated environmental impacts. This critical review explains the use of LCA methodology and outlines its application to external beam radiation therapy (EBRT) with the aim of providing a robust methodology to quantify the environmental impact of radiation therapy care practices today. The steps of an LCA are outlined and explained as defined by the International Organization for Standardization (ISO 14040 and 14044) guidelines: (1) definition of the goal and scope of the LCA, (2) inventory analysis, (3) impact assessment, and (4) interpretation. The existing LCA framework and its methodology is described and applied to the field of radiation oncology. The goal and scope of its application to EBRT is the evaluation of the environmental impact of a single EBRT treatment course within a radiation oncology department. The methodology for data collection via mapping of the resources used (inputs) and the end-of-life processes (outputs) associated with EBRT is explained, with subsequent explanation of the LCA analysis steps. Finally, the importance of appropriate sensitivity analysis and the interpretations that can be drawn from LCA results are reviewed. This critical review of LCA protocol provides and evaluates a methodological framework to scientifically establish baseline environmental performance measurements within a health care setting and assists in identifying targets for emissions mitigation. Future LCAs in the field of radiation oncology and across medical specialties will be crucial in informing best practices for equitable and sustainable care in a changing climate.

The Impact of Telemedicine in Reducing the Carbon Footprint in Health Care: A Systematic Review and Cumulative Analysis of 68 Million Clinical Consultations

CONTEXT

Carbon footprint (CF) has emerged as an important factor when assessing health care interventions.

OBJECTIVE

To investigate the reduction in CF for patients utilizing telemedicine.

EVIDENCE ACQUISITION

The PubMed, Scopus, and Web of Science databases were queried for studies describing telemedicine consultation and reporting on carbon emissions saved and the carbon emissions of telemedicine devices as primary outcomes, and travel distance and time and cost savings and safety as secondary outcomes. Outcomes were tabulated and calculated per consultation. Carbon emissions and travel distances were also calculated for each total study cohort. Risk of bias was assessed using the Newcastle-Ottawa scale, and the Oxford level of evidence was determined.

EVIDENCE SYNTHESIS

A total of 48 studies met the inclusion criteria, covering 68 465 481 telemedicine consultations and savings of 691 825 tons of CO2 emissions and 3 318 464 047 km of travel distance. Carbon assessment was mostly reported as the estimated distance saved using a conversion factor. Medical specialties used telemedicine to connect specialists with patients at home (n = 25) or at a local center (n = 6). Surgical specialties used telemedicine for virtual preoperative assessment (n = 9), follow-up (n = 4), and general consultation (n = 4). The savings per consultation were 21.9-632.17 min and $1.85-$325. More studies focused on the COVID-19 time frame (n = 33) than before the pandemic (n = 15). The studies are limited by calculations, mostly for the travel distance for carbon savings, and appropriate follow-up to analyze the real impact on travel and appointments.

CONCLUSIONS

Telemedicine reduces the CF of the health care sector. Expanding the use of telemedicine and educating providers and patients could further decrease CO2 emissions and save both money and time.

PATIENT SUMMARY

We reviewed 48 studies on the use of telemedicine. We found that people used their cars less and saved time and money, as well as CO2 emissions, if they used teleconsultations. Some studies only looked at how much CO2 from driving was saved, so there might be more to learn about the benefits of teleconsultations. The use of online doctor appointments is not only good for our planet but also helps patients in saving time and money. This review is registered on the PROSPERO database for systematic reviews (CRD42023456839).

Breast and Colorectal Cancer Screening Utilization after Hurricane María and the COVID-19 Pandemic in Puerto Rico

Puerto Rico (PR) has faced environmental and public health challenges that could have significantly affected cancer screening access. Using administrative claims data from PR's Medicaid population, this study assessed trends in colorectal and breast cancer screening from 2016 to 2021, the impact of disasters in screening, and the absolute deficit in screening due to the pandemic. The monthly rates of claims were analyzed using Poisson regression. Significant reductions in breast and colorectal cancer screening utilization were observed. The colorectal cancer screening rate in 2017 was 77% lower a month after Hurricanes Irma and María [RRadj: 0.23; 95% CI: 0.20, 0.25] compared to the same time period in 2016. Breast cancer screening dropped 50% in November 2017 compared to November 2016 [RRadj: 0.50; 95% CI: 0.47, 0.54]. Prospectively, a recovery in utilization has been observed only for breast cancer screening. The results revealed that cancer screening utilization substantially declined after environmental disasters and the pandemic. These findings have potentially severe long-term implications for cancer health disparities and mortality in PR.

Disasters and kidney care: pitfalls and solutions

Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.

Maintaining quality of life and care for cancer survivors experiencing disaster disruptions: a review of the literature

Disasters caused by natural phenomena are increasing in frequency and devastation. The growing number of cancer survivors constitute a vulnerable population in their need for continuous and high-level care, a vulnerability that is exacerbated in the event of disasters. Although the evidence base on the needs of cancer survivors is growing, little is known about cancer care in disaster settings. Therefore, we prepared a narrative literature review that outlines existing evidence, identifies knowledge gaps, and clarifies key concepts that are central to the burgeoning area of research into the quality of care for cancer survivors through disasters. As the preponderance of available evidence stresses the importance of careful disaster planning for maintaining care services, this review also provides guidance in developing plans for how to proceed during, and in the aftermath of, disasters.

Climate disasters and oncology care: a systematic review of effects on patients, healthcare professionals, and health systems

PURPOSE

Climate disasters have devastating effects on communities and society that encompass all aspects of daily life, including healthcare. Patients with cancer are particularly vulnerable when disaster strikes. As the number and intensity of disasters increases, it is important to understand the effects across the cancer care continuum. This systematic review investigates the effect of climate disasters on patients, the oncology healthcare workforce, and healthcare systems.

METHODS

A medical librarian conducted a literature search in PubMed, Embase, CINAHL, and Web of Science from January 1, 2016, through May 11, 2022. Eligible studies included any published report on a climate disaster globally reporting on patient-, oncology healthcare workforce-, or healthcare systems-level outcomes. Study quality was assessed, and findings were narratively synthesized, given the diversity of reported evidence.

RESULTS

The literature search identified 3618 records, of which 46 publications were eligible for inclusion. The most frequent climate disaster was hurricanes (N = 27) followed by tsunami (N = 10). Eighteen publications were from disasters that occurred in the mainland USA with 13 from Japan and 12 from Puerto Rico. Patient-level outcomes included treatment interruptions and inability to communicate with the healthcare team. At the workforce level, findings included distressed clinicians caring for others when their own lives have been affected by a disaster along with lack of disaster preparedness training. Health systems reported closures or shifting services post-disaster and a need to have improved emergency response plans.

CONCLUSION

Response to climate disasters necessitates a holistic approach at the patient, workforce, and health systems levels. Specifically, interventions should focus on mitigating interruptions in care for patients, advanced coordination and planning for workforce and health systems, and contingency planning for allocation of resources by health systems.

A Qualitative Approach to Explore Perceptions, Opinions and Beliefs of Communities who Experienced Health Disparities towards Chronic Health Conditions

The prevalence of chronic medical conditions is associated with biological, behavioral, and social factors. In Puerto Rico (PR), events such as budget cuts to essential services in recent years have contributed to deepening health disparities. This study aimed to explore community perceptions, opinions, and beliefs about chronic health conditions in the southern region of Puerto Rico. Framed by a Community-Based Participatory Research (CBPR) approach, this qualitative study developed eight focus groups (n = 59) with adults (age of 21 or older) from southern Puerto Rico, in person and remotely, during 2020 and 2021. Eight open-ended questions were used for discussions, which were recorded, transcribed, and analyzed via computer analysis. Content analysis revealed four main dimensions: knowledge, vulnerabilities, barriers, and identified resources. Relevant topics included: concerns about mental health-depression, anxiety, substance use, and suicide; individual vulnerabilities-risk behaviors, and unhealthy habits; economic factors-health access and commercialization of health. Resource identification was also explored, and participants discussed the importance of alliances between public and private sectors. These topics were addressed across all focus groups, with various recommendations. The results highlight the importance of prioritizing identified community needs, evaluating available resources, and promoting tailored-made interventions to reduce risk factors for chronic health conditions.

Climate toxicity: An increasingly relevant clinical issue in Cancer Care

In recent years the terms time and financial toxicities have entered the vocabulary of cancer care. We would like to introduce another toxicity: climate toxicity. Climate toxicity is a double-edge sword in cancer care. Increasing cancer risk by exposure to carcinogens, and consequently increasing treatment requirements leads to ever growing damage to our environment. This article assesses the impact of climate change on patients, the climate toxicity caused by both healthcare workers and healthcare facilities, and suggests actions that may be taken mitigate them.

Precision public-health intervention for care coordination: a real-world study

BACKGROUND

Health emergencies disproportionally affect vulnerable populations. Digital tools can help primary care providers find, and reach, the right patients.

AIM

To evaluate whether digital interventions delivered directly to GPs' clinical software were more effective at promoting primary care appointments during the COVID-19 pandemic than interventions delivered by post.

DESIGN AND SETTING

Real-world, non-randomised, interventional study involving GP practices in all Australian states.

METHOD

Intervention material was developed to promote care coordination for vulnerable older veterans during the COVID-19 pandemic, and sent to GPs either digitally to the clinical practice software system or in the post. The intervention material included patient-specific information sent to GPs to support care coordination, and education material sent via post to veterans identified in the administrative claims database. To evaluate the impact of intervention delivery modalities on outcomes, the time to first appointment with the primary GP was measured; a Cox proportional hazards model was used, adjusting for differences and accounting for pre-intervention appointment numbers.

RESULTS

The intervention took place in April 2020, during the first weeks of COVID-19 social distancing restrictions in Australia. GPs received digital messaging for 51 052 veterans and postal messaging for 26 859 veterans. The digital group was associated with earlier appointments (adjusted hazard ratio 1.38 [1.34 to 1.41]).

CONCLUSION

Data-driven digital solutions can promote care coordination at scale during national emergencies, opening up new perspectives for precision public-health initiatives.

Impact of COVID-19 on Cancer-Related Care in the United States: An Overview

COVID-19 impacted several health services, including cancer-related care. Its implications were significant due to the lapse in hospital resources, compounded by the delays stemming from the economic effects on patients' jobs and medical coverage. Furthermore, reports suggesting an increased risk for morbidity and mortality from COVID-19 in patients with cancer and those on active cancer treatment caused additional fear and potential delays in seeking medical services. This review provides an overview of the pandemic's impact on cancer care in the United States and suggests measures for tackling similar situations in the future.

Estimated Carbon Emissions Savings With Shifts From In-Person Visits to Telemedicine for Patients With Cancer

IMPORTANCE

While the health care community advocates broadly for climate change policy, medical professionals can look within care practices to assess their contribution to carbon dioxide (CO2) emissions, and provide solutions wherever possible. Telemedicine can help in mitigating climate change by providing care from a distance.

OBJECTIVE

To assess the carbon savings achieved from telemedicine visits.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study of telemedicine visits was conducted at a single-institution National Cancer Institute (NCI)-designated comprehensive cancer center. Eligible patients were aged 18 years and above, completed telemedicine visits from April 1, 2020, to June 20, 2021, and had a Florida mailing address documented in their electronic medical record. Groups were divided between those within driving time of 60 minutes (1-way) to the cancer center vs those living beyond 60 minutes of drive time. Data were analyzed between April 2020 and June 2021.

MAIN OUTCOMES AND MEASURES

Carbon emission savings from telemedicine, measured in total and average per-visit savings.

RESULTS

A total 49 329 telemedicine visits with 23 228 patients were conducted from April 1, 2020, to June 30, 2021. A total 21 489 visits were for patients with driving time of 60 minutes or less (median [IQR] age, 62.0 [52.0-71.0] years; 12 334 [57.4%] female; 1685 [7.8%] Black, 1500 [7.0%] Hispanic, 16 010 [74.5%] non-Hispanic White), while 27 840 visits were for patients with driving time greater than 60 minutes (median [IQR] age, 67.0 [57.0-74.0] years; 14 372 [51.6%] female; 1056 [3.8%] Black, 1364 [5.0%] Hispanic, 22 457 [80.7%] non-Hispanic White). For patients living within a driving time of 60 minutes from the cancer center, 424 471 kg CO2 emissions were saved (mean [SD] emissions savings, 19.8 [9.4] kg CO2 per visit) due to telemedicine-equivalent to 91.5 passenger vehicles driven for 1 year. For patients whose driving distance was greater than 60 minutes, 2 744 248 kg CO2 emissions were saved (mean emissions savings, 98.6 [54.8] kg CO2 per visit)-equivalent to 591 passenger vehicles driven for 1 year.

CONCLUSIONS AND RELEVANCE

Using a large data set, this cross-sectional analysis highlighted the carbon emissions savings due to telemedicine in oncology. This has important implications in reducing health care-related carbon footprint.

Delays and declines in seasonal influenza vaccinations due to Hurricane Harvey narrow annual gaps in vaccination by race, income and rurality

OBJECTIVE

Temporal overlap of the Atlantic hurricane season and seasonal influenza vaccine rollout has the potential to result in delays or disruptions of vaccination campaigns. We documented seasonal influenza vaccination behavior over a 5-year period and explored associations between flooding following Hurricane Harvey and timing and uptake of vaccines, as well as how the impacts of Hurricane Harvey on vaccination vary by race, wealth, and rurality.

DESIGN

Retrospective cohort analysis.

SETTING

Texas counties affected by Hurricane Harvey.

PATIENTS

Active users of the Veterans' Health Administration in 2017.

METHODS

We used geocoded residential address data to assess flood exposure status following Hurricane Harvey. Days to receipt of seasonal influenza vaccines were calculated for each year from 2014 to 2019. Proportional hazards models were used to determine how likelihood of vaccination varied according to flood status as well as the race, wealth, and rural-urban residence of patients.

RESULTS

The year of Hurricane Harvey was associated with a median delay of 2 weeks to vaccination and lower overall vaccination than in prior years. Residential status in flooded areas was associated with lower hazards of influenza vaccination in all years. White patients had higher proportional hazards of influenza vaccination than non-White patients, though this attenuated to 6.39% (hazard ratio [HR], 1.0639; 95% confidence interval [CI], 1.034-1.095) in the hurricane. year.

CONCLUSIONS

Receipt of seasonal influenza vaccination following regional exposure to the effects of Hurricane Harvey was delayed among US veterans. White, non-low-income, and rural patients had higher likelihood of vaccination in all years of the study, but these gaps narrowed during the hurricane year.

Maternal and Child Health Care Service Disruptions and Recovery in Mozambique After Cyclone Idai: An Uncontrolled Interrupted Time Series Analysis

INTRODUCTION

Climate change-related extreme weather events have increased in frequency and intensity, threatening people's health, particularly in places with weak health systems. In March 2019, Cyclone Idai devastated Mozambique's central region, causing infrastructure destruction, population displacement, and death. We assessed the impact of Idai on maternal and child health services and recovery in the Sofala and Manica provinces.

METHODS

Using monthly district-level routine data from November 2016 to March 2020, we performed an uncontrolled interrupted time series analysis to assess changes in 10 maternal and child health indicators in all 25 districts before and after Idai. We applied a Bayesian hierarchical negative binomial model with district-level random intercepts and slopes to estimate Idai-related service disruptions and recovery.

RESULTS

Of the 4.44 million people in Sofala and Manica, 1.83 (41.2%) million were affected. Buzi, Nhamatanda, and Dondo (all in Sofala province) had the highest proportion of people affected. After Idai, all 10 indicators showed an abrupt substantial decrease. First antenatal care visits per 100,000 women of reproductive age decreased by 23% (95% confidence interval [CI]=0.62, 0.96) in March and 11% (95% CI=0.75, 1.07) in April. BCG vaccinations per 1,000 children under age 5 years declined by 21% (95% CI=0.69, 0.90) and measles vaccinations decreased by 25% (95% CI=0.64, 0.87) in March and remained similar in April. Within 3 months post-cyclone, almost all districts recovered to pre-Idai levels, including Buzi, which showed a 22% and 13% relative increase in the number of first antenatal care visits and BCG, respectively.

CONCLUSION

We found substantial health service disruptions immediately after Idai, with greater impact in the most affected districts. The findings suggest impressive recovery post-Idai, emphasizing the need to build resilient health systems to ensure quality health care during and after natural disasters.

Impact of Seismic Activity on Access to Health Care in Hispanic/Latino Cancer Patients from Puerto Rico

On 7 January 2020, the southern region of Puerto Rico was struck by a 6.4 magnitude earthquake, followed by continual seismic activity. Our team performed secondary analyses to explore the relationship between exposure to seismic activity, protection (support) received, and barriers to health care access for cancer patients. Methods: The research team collected data from the database of a longitudinal case-control cohort parent study concerning the impact of Hurricane Maria in Puerto Rican cancer patients. The participants from the parent study were recruited in community clinics. The extracted data was collected from 51 cancer patients who completed the parent study’s interviews from January−July 2020 (seismic activity period). Barriers to health care were assessed using the Barrier to Care Questionaries (BCQ), which is composed of five subscales: skills, marginalization, knowledge and beliefs expectations, and pragmatics. Exposure to seismic activity and protection was assessed using their respective subscales from the Scale of Psychosocial Impact of Disasters. Results: The results showed a significant relationship between exposure to seismic activity and barriers to health care (p < 0.001) and its five subscales (p < 0.01). These results shed light on potential access to care barriers that could hinder cancer patient treatment in the event of a natural disaster.

Impact of the COVID-19 pandemic on referral to and delivery of gynecologic oncology care

•

The COVID-19 pandemic has significantly impacted gynecologic cancer care.

•

Referrals to gynecologic oncology decreased in the early months of the pandemic.

•

Referral time to gynecologic oncology evaluation was not impacted by the pandemic.

•

Time to cancer treatment initiation decreased significantly during the pandemic.

•

Disparities in time to cancer treatment initiation improving during the pandemic.

Objective

To evaluate the impact of the COVID-19 pandemic on referral to and delivery of gynecologic oncology care at a National Cancer Institute-designated Comprehensive Cancer Center.

Methods

We conducted a retrospective cohort study of patients referred for evaluation by a gynecologic oncologist at Washington University in St. Louis from October 2019 – February 2020 (pre-COVID-19), and April - August 2020 (COVID-19). The primary outcome, time from referral to evaluation by a gynecologic oncologist, was compared between the two time periods. Secondary outcomes included time from initial evaluation to treatment and delays/interruptions in care due to the pandemic. Sub-group analyses were performed on patients with a cancer diagnosis to evaluate the impact of COVID-19 on treatment decision making.

Results

884 patients were referred during the study period. Total referrals fell by 32% (526 to 358 patients, p < 0.001) and referrals for cancer fell by 18% (228 to 188 patients, p = 0.049). The pandemic did not impact time from referral to initial gynecologic oncology appointment overall (pre-COVID-19: 19.1 vs. COVID-19: 17.4 days, p = 0.315) or among patients with cancer (14.4 vs. 13.9 days, p = 0.662). Time from initial appointment to cancer treatment decreased by 9 days (34 days to 25 days, p = 0.001).

Conclusion

Referrals to gynecologic oncology decreased significantly during the early months of COVID-19. Though time from referral to evaluation was not impacted by the pandemic, time to treatment initiation decreased despite institutional changes related to COVID-19.

Contingency planning for cancer care in low- and middle-income countries during the COVID-19 pandemic: a rapid assessment for future disaster resilience

BACKGROUND

Many countries appear to be ill-prepared in their emergency responses towards the Corona Virus Disease 2019 (COVID-19) pandemic, particularly in managing chronic diseases such as cancer. We aimed to gain insight on the preparedness of health systems within low- and middle-income countries (LMICs) in maintaining delivery of cancer care amid the pandemic.

METHODS

We performed a rapid review of publications focusing on emergency contingency plans for cancer care during the pandemic in LMICs. An online desk research was conducted to identify relevant policy documents, guidelines or scientific publications.

RESULTS

Very few LMICs had readily accessible documents to ensure continuity in delivery of cancer care during the pandemic. A majority of publications were focused on delivery of cancer treatment whereas early detection, diagnosis and delivery of supportive and survivorship care received very little attention. Far fewer of the published guidelines appear to have been formulated at the national level by governmental agencies. A vast majority of publications constituted consensus guidelines from professional societies, followed by sharing of best practices from local institutions. Overall, three main strategies have been recommended to maintain delivery of cancer care amid the pandemic in LMICs: 1) Modification of cancer treatment regimens, 2) Changes in methods of administration of curative and supportive cancer care and 3) Implementation of generic measures to reduce the risk of COVID-19 infection in healthcare settings.

CONCLUSION

All LMICs should consider collating best practices from the current pandemic and translating them into an explicit cancer preparedness plan, which can be escalated during future disasters.

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

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.

The Perioperative Patient Experience During COVID-19

Background

Access to elective surgical procedures has been impacted by the COVID-19 pandemic.

Methods

We sought to understand the patient experience by developing and distributing an anonymous online survey to those who underwent non-emergency surgery at a large academic tertiary medical center between March and October 2020.

Results

The survey was completed by 184 patients; the majority were white (84%), female (74.6%), and ranged from 18 to 88 years old. Patients were likely unaware of case delay as only 23.6% reported a delay, 82% of which agreed with that decision. Conversely, 44% felt that the delay negatively impacted their quality of life. Overall, 82.7% of patients indicated high satisfaction with their care. African American patients more often indicated a “neutral” vs “satisfactory” hospital experience (P < .05) and considered postponing their surgery (P < .01). Interestingly, younger patients (<60) were more likely than older (≥60) patients to note anxiety associated with having surgery during the pandemic (P < .01), feeling unprepared for discharge (P < .02), not being allowed visitors (P < .02), and learning about the spread of COVID-19 from health care providers (P < .02).

Discussion

These results suggest that patients are resilient and accepting of changes to health care delivery during the current pandemic; however, certain patient populations may have higher levels of anxiety which could be addressed by their care provider. These findings can help inform and guide ongoing and future health care delivery adaptations in response to care disruptions.

The long term participation trend for the colorectal cancer screening after the 2011 triple disaster in Minamisoma City, Fukushima, Japan

Colorectal cancer (CRC) screening is a well-established cancer screening method, and its effectiveness depends on maintaining a high participation rate in the target population. In this study, we analyzed the trends in CRC screening participation rates over 10 years in Minamisoma City, where residents were forced to evacuate after the 2011 triple disaster in Fukushima, Japan. The immunochemical fecal occult blood test is provided as municipal CRC screening. We calculated the annual CRC screening participation rate and analyzed the factors associated with participation in screening. Overall, 4069 (12.3%) and 3839 (11.7%) persons participated in CRC screening in 2009 and 2010, respectively; however, the number decreased significantly to 1090 (3.4%) in 2011 when the earthquake occurred. Over the following 3 years, the rate gradually recovered. Multivariable logistic analysis showed that age < 65 years, living alone, and evacuation were significant associated factors for non-participation after 2011 (p < 0.05). In conclusion, the CRC screening participation rate decreased significantly during the Great East Japan Earthquake but recovered over the next 3 years. Further analysis of factors preventing CRC screening participation and research on the long-term effects of its post-disaster decline are important to consider in assessing the need for intervention in post-disaster cancer screening.

The trajectory of racial/ethnic disparities in the use of cancer screening before and during the COVID-19 pandemic: A large U.S. academic center analysis

Cancer screening rates declined sharply early in the COVID-19 pandemic. The impact of the pandemic may have exacerbated existing disparities in cancer screening due to the disproportionate burden of illness and job loss among racial/ ethnic minorities, and potentially, uneven resumption of care between different racial/ ethnic groups. Using electronic health record data from Mass General Brigham (MGB), we assessed changes in rates of breast, cervical, colorectal and lung cancer screening before and during the pandemic. Among patients who received primary care in an MGB-affiliated primary care practice, cancer screening rates were calculated as the number of individuals who received a screening test for each cancer type over the number of individuals due for each test, during each month between April 2019-November 2020. We conducted an interrupted time-series analysis to test for changes in screening rates by race/ethnicity before and during the pandemic. Prior to the pandemic, relative to White individuals, Asian women were less likely to receive breast cancer screening (p < 0.001), and Latinx and Black individuals were less likely to screen for lung cancer (p < 0.001 and p = 0.02). Our results did not show significant improvement or worsening of racial/ethnic disparities for any cancer screening type as screening resumed. However, as of November 2020 rates of screening for breast cancer were lower than pre-pandemic levels for Latinx individuals, and lung cancer screening rates were higher than baseline for Latinx, Black or White individuals. Further monitoring of disparities in cancer screening is warranted as the pandemic evolves.

Analysis of the Impact of the COVID-19 Pandemic on the Multidisciplinary Management of Breast Cancer: Review from the American Society of Breast Surgeons COVID-19 and Mastery Registries

Background

The coronavirus disease 2019 (COVID-19) pandemic has resulted in rapid and regionally different approaches to breast cancer care.

Methods

In order to evaluate these changes, a COVID-19-specific registry was developed within the American Society of Breast Surgeons (ASBrS) Mastery that tracked whether decisions were usual or modified for COVID-19. Data on patient care entered into the COVID-19-specific registry and the ASBrS Mastery registry from 1 March 2020 to 15 March 2021 were reviewed.

Results

Overall, 177 surgeons entered demographic and treatment data on 2791 patients. Mean patient age was 62.7 years and 9.0% (252) were of African American race. Initial consultation occurred via telehealth in 6.2% (173) of patients and 1.4% (40) developed COVID-19. Mean invasive tumor size was 2.1 cm and 17.8% (411) were node-positive. In estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2−) disease, neoadjuvant endocrine therapy (NET) was used as the usual approach in 6.9% (119) of patients and due to COVID-19 in an additional 31% (542) of patients. Patients were more likely to receive NET due to COVID-19 with increasing age and if they lived in the Northeast or Southeast (odds ratio [OR] 1.1, 2.3, and 1.7, respectively; p < 0.05). Genomic testing was performed on 51.5% (781) of estrogen-positive patients, of whom 20.7% (162) had testing on the core due to COVID-19. Patients were less likely to have core biopsy genomic testing due to COVID-19 if they were older (OR 0.89; p = 0.01) and more likely if they were node-positive (OR 4.0; p < 0.05). A change in surgical approach due to COVID-19 was reported for 5.4% (151) of patients.

Conclusion

The ASBrS COVID-19 registry provided a platform for monitoring treatment changes due to the pandemic, highlighting the increased use of NET.

Identifying and Describing Impact of Disasters on Non-Communicable Diseases: A Systematic Review

BACKGROUND

Patients with non-communicable diseases are vulnerable to disasters. This is a systematic review describing the impact of disasters on non-communicable diseases.

METHODS

A systematic review was conducted using PRISMA standards. Relevant articles published from 1997 to 2019 collected by searching the Scopus, PubMed, Science Direct, databases. We specifically examined reports describing NCDs and including the key words "non-communicable disease and Disasters". NCDs included cardiovascular, respiratory, diabetes, cancer and mental health diseases.

RESULTS

Of the 663 studies identified, only 48 articles met all the eligibility criteria. Most studies have shown the impact of all natural disasters on non-communicable diseases (39.8% n=19). The largest study was the effect of earthquakes on non-communicable diseases (29.2% n=14). For the NCDs targeted by this research, most of the included studies were a combination of four diseases: cardiovascular disease, respiratory disease, diabetes and cancer (44% n=21). Followed by cardiovascular disease (14.6% n=7), chronic respiratory disease (12.5% n=6), diabetes and cancer (6.2% n=3) and mental health (12.5% n=6).

CONCLUSION

The incidence of disasters affects the management of treatment and care for patients with NCDs. Specific measures include a multi-part approach to ensuring that patients with non-communicable diseases have access to life-saving services during and after disasters. The approach of the health system should be expanded from traditional approaches to disasters and requires comprehensive planning of health care by policy makers and health professionals to develop effective strategies to enable patients to access medical, therapeutic and diagnostic services in natural disasters.

Decreased Medical Care During the COVID-19 Pandemic - A Comprehensive Analysis of Radiological Examinations

OBJECTIVES

As a cross-section discipline within the hospital infrastructure, radiological departments might be able to provide important information regarding the impact of the COVID-19 pandemic on healthcare. The goal of this study was to quantify changes in medical care during the first wave of the pandemic using radiological examinations as a comprehensive surrogate marker and to determine potential future workload.

METHODS

A retrospective analysis of all radiological examinations during the first wave of the pandemic was performed. The number of examinations was compared to time-matched control periods. Furthermore, an in-depth analysis of radiological examinations attributed to various medical specialties was conducted and postponed examinations were extrapolated to calculate additional workload in the near future.

RESULTS

A total of 596,760 examinations were analyzed. Overall case volumes decreased by an average of 41 % during the shutdown compared to the control period. The most affected radiological modalities were sonography (-54 %), X-ray (-47 %) followed by MRI (-42 %). The most affected medical specialty was trauma and orthopedics (-60 % case volume) followed by general surgery (-49 %). Examination numbers increased during the post-shutdown period leading to a predicted additional workload of up to 22 %.

CONCLUSION

This study shows a marked decrease in radiological examinations in total and among several core medical specialties, indicating a significant reduction in medical care during the first COVID-19 shutdown.

KEY POINTS

· Number of radiological examinations decreased by 41 % during the first wave of the COVID-19 pandemic.. · Several core medical specialties were heavily affected with a reduction of case volumes up to 60 %.. · When extrapolating postponed examinations to the near future, the overall workload for radiological departments might increase up to 22 %..

CITATION FORMAT

· Fleckenstein FN, Maleitzke T, Böning G et al. Decreased Medical Care During the COVID-19 Pandemic - A Comprehensive Analysis of Radiological Examinations. Fortschr Röntgenstr 2021; 193: 937 - 946.

Tropical cyclone exposure is associated with increased hospitalization rates in older adults

Hurricanes and other tropical cyclones have devastating effects on society. Previous case studies have quantified their impact on some health outcomes for particular tropical cyclones, but a comprehensive assessment over longer periods is currently missing. Here, we used data on 70 million Medicare hospitalizations and tropical cyclone exposures over 16 years (1999-2014). We formulated a conditional quasi-Poisson model to examine how tropical cyclone exposure (days greater than Beaufort scale gale-force wind speed; ≥34 knots) affect hospitalizations for 13 mutually-exclusive, clinically-meaningful causes. We found that tropical cyclone exposure was associated with average increases in hospitalizations from several causes over the week following exposure, including respiratory diseases (14.2%; 95% confidence interval [CI]: 10.9-17.9%); infectious and parasitic diseases (4.3%; 95%CI: 1.2-8.1%); and injuries (8.7%; 95%CI: 6.0-11.8%). Average decadal tropical cyclone exposure in all impacted counties would be associated with an estimated 16,772 (95%CI: 8,265-25,278) additional hospitalizations. Our findings demonstrate the need for targeted preparedness strategies for hospital personnel before, during, and after tropical cyclones.