In the Journals

Hurricane disaster declarations associated with shorter survival for patients receiving radiotherapy for lung cancer

Leticia Nogueira, PhD, MPH,
Leticia Nogueira

Patients undergoing radiation for non-small cell lung cancer at the time of a hurricane disaster declaration demonstrated shorter OS than patients who completed treatment under normal conditions, according to a research letter published in JAMA.

“Radiation therapy is particularly problematic during disasters because it is dependent on electricity, requires the presence of specialized teams for treatment delivery, and requires the daily presence of patients due to the regularity with which it is given,” Leticia Nogueira, PhD, MPH, principal scientist in the surveillance and health services research program at American Cancer Society, told HemOnc Today. “Therefore, the displacement of both patients and medical teams can impact the delivery of radiation therapy.”

Nogueira and colleagues used the National Cancer Database to compare outcomes of 1,734 patients with nonoperative locally advanced NSCLC (mean age, 66.5 years; 55% men) who were undergoing radiotherapy when a hurricane disaster was declared in their treatment facility’s area with those of 1,734 patients (mean age, 66.4 years; 55% men) treated at the same facility in the absence of a disaster declaration.

Researchers propensity score-matched exposed and unexposed patients by age, sex, stage of disease, month of radiotherapy initiation and median income.

Federal Emergency Management Agency data showed 101 hurricane disaster declarations, ranging from 1 day to 69 days, were issued during the study period from 2004 to 2014.

Patients impacted by a hurricane disaster, compared with unexposed patients, had longer treatment durations (66.9 days vs. 46.2 days) and significantly shorter OS in both crude (HR for death = 1.11; 95% CI, 1.02-1.22) and adjusted (HR for death = 1.19; 95% CI, 1.07-1.32) analyses. Adjusted RR for death increased to 1.27 (95% CI, 1.12-1.44) for disasters lasting 27 days; however, the association became nonsignificant after 30 days — and only 19 declarations lasted that long.

Overall, 1,408 patients exposed to a hurricane disaster declaration during treatment died. Mean OS for these patients was 29 months, and the 5-year survival estimate was 14.5%.

In the unexposed group, 1,331 patients died. Mean OS was 31 months, and the 5-year survival estimate was 15.4%.

A lack of information on smoking history, performance status, treatment toxicity, displacement, mental health status and physical functioning served as study limitations.

Nogueira said that better preparation for natural disasters, such as by adding patients with cancer to the regular response plan, could help prevent therapy interruptions.

“Although it is not possible to guarantee the supply of electrical power during a disaster, it is still possible to prevent treatment interruptions by including patients with cancer in disaster response planning,” Nogueira said. “We recommend that patients with cancer undergoing daily radiation treatment be identified prior to a hurricane, treatment be transferred to a different facility, and insurance out-of-network charges be eliminated.”

Nogueira added that this will be particularly important as climate change brings stronger and more unpredictable storms.

“Climate change is already decreasing the speed and increasing the water capacity of hurricanes, which increases the probability of catastrophic rainfall when storms stall over populated areas,” Nogueira said. “By altering the behavior of storms, climate change makes it harder for communities to prepare for disasters.” – by John DeRosier

For more information:

Leticia M. Nogueira, PhD, can be reached at Surveillance and Health Services Research Program, American Cancer Society, 250 Williams St., Atlanta, GA 30067; email: leticia.nogueira@cancer.org.

Disclosures: Nogueira reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Leticia Nogueira, PhD, MPH,
Leticia Nogueira

Patients undergoing radiation for non-small cell lung cancer at the time of a hurricane disaster declaration demonstrated shorter OS than patients who completed treatment under normal conditions, according to a research letter published in JAMA.

“Radiation therapy is particularly problematic during disasters because it is dependent on electricity, requires the presence of specialized teams for treatment delivery, and requires the daily presence of patients due to the regularity with which it is given,” Leticia Nogueira, PhD, MPH, principal scientist in the surveillance and health services research program at American Cancer Society, told HemOnc Today. “Therefore, the displacement of both patients and medical teams can impact the delivery of radiation therapy.”

Nogueira and colleagues used the National Cancer Database to compare outcomes of 1,734 patients with nonoperative locally advanced NSCLC (mean age, 66.5 years; 55% men) who were undergoing radiotherapy when a hurricane disaster was declared in their treatment facility’s area with those of 1,734 patients (mean age, 66.4 years; 55% men) treated at the same facility in the absence of a disaster declaration.

Researchers propensity score-matched exposed and unexposed patients by age, sex, stage of disease, month of radiotherapy initiation and median income.

Federal Emergency Management Agency data showed 101 hurricane disaster declarations, ranging from 1 day to 69 days, were issued during the study period from 2004 to 2014.

Patients impacted by a hurricane disaster, compared with unexposed patients, had longer treatment durations (66.9 days vs. 46.2 days) and significantly shorter OS in both crude (HR for death = 1.11; 95% CI, 1.02-1.22) and adjusted (HR for death = 1.19; 95% CI, 1.07-1.32) analyses. Adjusted RR for death increased to 1.27 (95% CI, 1.12-1.44) for disasters lasting 27 days; however, the association became nonsignificant after 30 days — and only 19 declarations lasted that long.

Overall, 1,408 patients exposed to a hurricane disaster declaration during treatment died. Mean OS for these patients was 29 months, and the 5-year survival estimate was 14.5%.

In the unexposed group, 1,331 patients died. Mean OS was 31 months, and the 5-year survival estimate was 15.4%.

A lack of information on smoking history, performance status, treatment toxicity, displacement, mental health status and physical functioning served as study limitations.

Nogueira said that better preparation for natural disasters, such as by adding patients with cancer to the regular response plan, could help prevent therapy interruptions.

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“Although it is not possible to guarantee the supply of electrical power during a disaster, it is still possible to prevent treatment interruptions by including patients with cancer in disaster response planning,” Nogueira said. “We recommend that patients with cancer undergoing daily radiation treatment be identified prior to a hurricane, treatment be transferred to a different facility, and insurance out-of-network charges be eliminated.”

Nogueira added that this will be particularly important as climate change brings stronger and more unpredictable storms.

“Climate change is already decreasing the speed and increasing the water capacity of hurricanes, which increases the probability of catastrophic rainfall when storms stall over populated areas,” Nogueira said. “By altering the behavior of storms, climate change makes it harder for communities to prepare for disasters.” – by John DeRosier

For more information:

Leticia M. Nogueira, PhD, can be reached at Surveillance and Health Services Research Program, American Cancer Society, 250 Williams St., Atlanta, GA 30067; email: leticia.nogueira@cancer.org.

Disclosures: Nogueira reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.