Natural disasters like hurricanes and wildfires impact access to care for patients with cancer, concluded 2 separate studies that were presented at the 2024 ASCO Quality Care Symposium.
In 1 study, which was presented just days before Hurricane Milton made landfall in Florida, it was concluded that exposure to hurricanes can disrupt cancer care, and among patients diagnosed with locally advanced non–small cell lung cancer (NSCLC), disruptions in radiation can potentially decrease chances of survival.1
In the first study, Rand Sakka, a health services researcher at the American Cancer Society (ACS), and colleagues identified patients aged ≥18 years from the National Cancer Database who initiated radiation therapy for inoperable stage III NSCLC between 2004 and 2021. The researchers defined hurricane exposure as “a Federal Emergency Management Agency (FEMA) hurricane disaster declaration at the county of the treating facility during radiation treatment.”1 Sakka and colleagues matched patients who were treated at the same facility but at a time when no hurricane happened (ie, unexposed) in a 1:1 ratio with exposed patients by age at diagnosis, sex, lymph node involvement, comorbidity score, and era (per radiation start year), to account for more active hurricane seasons in recent years. Delays in radiation treatment completion were defined as more than 8 weeks between the date radiation started and ended.
The results included 6260 matched patients, of whom 3130 were treated at facilities exposed to hurricanes during radiation and 3130 who completed treatment at the same facilities when no hurricane exposure happened. Patients treated during hurricanes had 1.95 higher odds of experiencing treatment delays compared with unexposed patients, and exposed patients were more likely to have received higher radiation doses and completed more fractions compared with unexposed patients.
Researchers noted in their conclusions that “As severe weather events become more common, comprehensive emergency preparedness plans that incorporate evidence-based strategies for mitigating the adverse effects of treatment delays are essential.”1
In another study, Leticia M. Nogueira, PhD, MPH, and other ACS researchers, looked at wildfire exposures and in-hospital length of stay (LOS) following lung cancer surgery. The researchers identified individuals aged ≥18 years from the National Cancer Database who received curative-intent lobectomy or pneumonectomy for stage I-III NSCLC between 2004 and 2021.2
The team defined exposure as “a FEMA Presidential Disaster Declaration in the county of the treatment facility between the date of surgery and the date of discharge from the hospital.”2
Study results demonstrated that those patients who were exposed to a wildfire disaster declaration in the county of the treating facility had longer LOS than unexposed patients (9.4 days compared with 7.5 days, respectively) overall and for each of the stages (I-III) for which surgery is the recommended treatment. In a sensitivity analysis, there was no in-hospital mortality difference between exposed and unexposed patients (10.8% and 10.5%, respectively).
Researchers in this study concluded that “future studies should “evaluate” whether extended hospital stay improves the safety and quality of surgical care. Moreover, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient populations.”2
References
- Sakka R, Chino F, Nogueira L, Yabroff R. Hurricane disasters and radiation treatment delays among patients diagnosed with non-small cell lung cancer. Presented at ASCO Quality Care Symposium. September 27-28, 2024. San Francisco, California. Poster board #B22
- Nogueira L, Yabroff R, Shultz JM, et al. Wildfire exposures and in-hospital length of stay following lung cancer surgery. JCO Oncol Pract. 2024;20(suppl 10).