Abstract LB-157: Impact of hurricane-related stressors and responses on oncology care and outcomes of women with gynecologic cancer in Puerto Rico

Abstract

Objective: Cancer patients have increased risk of poor outcomes after disasters. On September 2017 Hurricanes Irma and María affected Puerto Rico (PR) and US Virgin Islands, causing the population to experience major disruptions in essential services and environmental health issues. Using qualitative methods, this ongoing study documents the stressors, responses, and experiences of patients, and providers/organizations involved in the receipt and delivery of gynecologic oncology care in PR, respectively. Methods: We conducted two focus groups (November-December 2018) among women ≥21 years with gynecologic cancer (n=12) and eight key-informant interviews among providers/stakeholders who offer services to these population in PR. Patients’ interviews addressed psychosocial and environmental stressors and multi-level responses experienced by the women in the aftermath of the hurricanes, and concerns regarding their condition. Key-informants’ interviews addressed problems encountered in their clinics/organizations in the aftermath of the hurricanes, perceived stressors and risks of patients, and recommendations for future preparedness efforts. Sessions were audio-recorded and transcribed to identify emergent themes. Results: The focus groups evidence that all patients faced lasting difficulties having a healthy diet and with communication, electricity and water services. Women under the Government Health Plan (GHP) faced longer time without essential services and were less prepared for the hurricanes than those with private health insurance. None received disaster preparedness information from their clinics/physicians and all expressed feeling environmental stressors such as heat, mosquitoes, humidity, noise and air pollution produced by household electric generators. All patients experienced delay in cancer treatment, but women in the GHP had longer delays, as most public hospitals were saturated or inoperable. Key-informants expressed that clinics/organizations did not have an emergency plan in place, services were saturated because the collapse of many facilities, and that some patients decided to interrupt their treatments, and others experienced recurrence. The biggest obstacle was lack of effective communication between the government and the health services, calling for interdependence of systems, but with better communication. Conclusion: Study results are guiding the topics that will be assessed in the subsequent quantitative phase of this NCI sponsored project, and the development of a disaster management plan for cancer patients in PR. Results show that all components of disaster management (planning, preparedness, response and recovery) failed. Disparities in preparedness and healthcare interruption in patients in the GHP could affect patient outcomes. NCI Grant #R21CA239457. Citation Format: Ana P. Ortiz, Mirza Rivera, Sandra I. Garcia-Camacho, William Calo, Guillermo Tortolero-Luna, Sharee Umpierre, Istoni Daluz-Santana, Pablo Mendez. Impact of hurricane-related stressors and responses on oncology care and outcomes of women with gynecologic cancer in Puerto Rico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-157.

Effect of chronic comorbidities on quality of life of gynecologic cancer patients in Puerto Rico

“…This cross-sectional study analyzed data collected by the research “Impact of Hurricane-Related Stressors and Responses on Cancer Care and Health Outcomes of Women with Gynecologic Cancers from Puerto Rico and the Virgin Islands” ( 16 ), funded by the National Institute of Health (NIH Grant: 1R21CA239457-01). In the parent study, a telephone-based interview was used to assess demographic, clinical, and lifestyle variables among women aged ≥21 years with a diagnosis of gynecologic cancer ( 16 ). Telephone-based interviews have been used in several studies, due to high reliability, compliance rate, and convenience for the investigator and the participants ( 17 , 18 ).…”

“…It is possible to interview individuals who may not otherwise be available due to their location and minimizes interviewer bias ( 17 ). Also, part of the interview process took place during the COVID-19 pandemic, making it an ideal method for continuing the investigation ( 16 ).…”

“…Data were entered in REDCap (Research Electronic Data Capture) by trained interviewers ( 16 ). Comorbidities evaluated were diabetes (types I and II), cardiovascular disease (hypertension and heart disease), and autoimmune diseases (lupus, HIV, rheumatoid arthritis, and Crohn’s disease), assessed through self-report of study participants.…”

“…The six QoL questions were available in the study questionnaire and previously used by the Behavioral Risk Factor Surveillance Survey ( 16 , 19 ). QoL was divided in and assessed by two domains: physical and mental.…”

“…The physical domain was subdivided into: frequent limitations when performing daily activities (FAL); poor general health (PGH); and frequent physical distress (FPD). The mental domain was subdivided into: rare or no social-emotional support (RNSES); dissatisfaction with life (DL); and frequent mental distress (FMD) ( 16 , 19 ).…”