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 in 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. Data were analyzed through descriptive, frequencies, correlational, and linear 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, along with closeness in time from HM predicted more barriers to receiving health care. Several inflammatory cytokines, such as CD31, BDNF, TFF3, Serpin E-1, Vitamin D BP, VCAM-1, Osteopontin, Chitinase 3 like 1, MMP-9 and MIF were significantly upregulated in cancer survivors while BDNF, MMP9 and Osteopontin had significant positive correlations with barriers to care. HM significantly impacted Puerto Ricans psychosocial well-being. 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

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.…”

“…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. 26,31 Similar to other studies exploring people’s experiences post Hurricane Maria, 31 we also found that local communities, including neighbors, local organizations, and clinics, provided support and resources to help patients with their financial, physical, and psychological needs.…”