Impact of a natural disaster on access to care and biopsychosocial outcomes among Hispanic/Latino cancer survivors

Abstract

Cancer is the leading cause of death in Puerto Rico (PR). Hurricane Maria (HM) and its aftermath lead to widespread devastation on the island, including the collapse of the healthcare system. Medically fragile populations, such as cancer survivors, were significantly affected. The goal of this study was to assess the impact of HM on barriers to care, emotional distress, and inflammatory biomarkers among cancer survivors in PR. This exploratory longitudinal study was conducted in health care facilities and community support groups from PR. Cancer survivors (n = 50) and non-cancer participants (n = 50) completed psychosocial questionnaires and provided blood samples that were used to assess inflammatory cytokines levels. Among this cohort, we identified 41 matched cancer survivors/noncancer participants pairs. Data were analyzed through descriptive, frequencies, correlational, and regression analyses. Cancer survivors that were affected by HM reported increased barriers in accessing medical care, which were directly associated with anxiety, perceived stress, and post-traumatic symptomatology. Moreover, being a cancer survivor, predicted more barriers to receiving health care, especially in the first six weeks after the event, after which the effect was attenuated. Several inflammatory cytokines, such as CD31, BDNF, TFF3, Serpin E-1, VCAM-1, Vitamin D BP, and PDGF-AA, were significantly upregulated in cancer survivors while MMP9 and Osteopontin both had significant positive correlations with barriers to care. HM significantly impacted Puerto Ricans psychosocial wellbeing. Cancer survivors had significant barriers to care and showed increased serum inflammatory cytokines but did not show differences in anxiety, stress, and post-traumatic symptoms compared to non-cancer participants. Natural disasters can significantly alter an individual's daily life and lead to psychological distress, particularly in medically fragile populations such as cancer survivors. Hurricane Maria (HM) made landfall in Puerto Rico (PR) on September 20, 2017, as Category 4 storm, killing an estimated 2,975 people and causing an estimated $90 billion in damages 1-3. Widespread devastation included loss of power and potable water infrastructure; destruction of buildings, bridges, and roads; lack of telecommunications; and closing of ports and airports 4. Lack of access to food and clean water was a significant problem for residents of PR 4. Mudslides rendered many roads in rural

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

“…Our findings are consistent with a recent study conducted in PR with 41 matched cancer survivors and non-cancer patient pairs. 26 That study found that cancer survivors experienced more barriers to access medical care compared to non-cancer patients, especially in the first 6 weeks after Hurricane Maria. 26 Patients in our study said that disruptions in cancer care were mostly caused by damage to health care infrastructure and loss of utility services.…”

“… 26 That study found that cancer survivors experienced more barriers to access medical care compared to non-cancer patients, especially in the first 6 weeks after Hurricane Maria. 26 Patients in our study said that disruptions in cancer care were mostly caused by damage to health care infrastructure and loss of utility services. Their experiences align with findings from a recent systematic review showing that electricity and water supply are often damaged when hurricanes hit, leading to service disruption in cancer care facilities, resulting in extended closure of units and subsequent oncology treatment delays.…”

“…Our observations are consistent with a biopsychosocial study reporting that Puerto Rican cancer survivors had greater levels of depression and greater resiliency vs non-cancer individuals in the aftermath of Hurricane Maria. 26 The authors concluded that patients had a tendency to conceal emotional distress to protect loved ones from worrying. 26 Our observations align with common cultural values in the Puerto Rican community and Hispanics in general, where family relationships are often prioritized before an individual’s well-being.…”

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

“…Recent literature shows that one of the primary concerns of cancer patients following a natural disaster is access to treatment [ 18 ]. Moreover, a study conducted on cancer patients showed that Hurricane Maria caused long-lasting effects on barriers to health care [ 19 ]. This data supports the need for investment in healthcare infrastructure to ease access to health care after a natural disaster.…”

Impact of the early COVID-19 era on endometriosis patients: Symptoms, stress, and access to care

“…A recent study conducted in Puerto Rico measured the impact of a Category 4 hurricane on barriers to care, emotional distress, and inflammatory biomarkers among cancer patients. 45 Barriers in accessing medical care were directly associated with perceived stress, anxiety, and post-traumatic symptomatology, and to increased levels of inflammatory cytokines. Our team has recently demonstrated that stress increases the size of endometriosis lesions and inflammation using a rat model, further proving that stress plays a key role in disease progression.…”