When hurricanes halt treatment, lung cancer patients die sooner

(Reuters Health) - Lung cancer patients whose radiation treatments are halted by hurricanes or other natural disasters may not live as long as patients who complete treatment without interruptions, a U.S. study suggests.

FILE PHOTO: Residents walk through flood water back to their raised house during Hurricane Barry in Plaquemines Parish, Louisiana, U.S. July 14, 2019. REUTERS/Jonathan Bachman

Cancer patients undergoing radiation therapy particularly vulnerable in disasters because they need reliable electricity for daily treatments, researchers note in JAMA. Previous research has linked even brief interruptions in daily radiation with worse survival.

The current study focused on patients with non-small cell lung cancer, the most common form. Researchers followed 1,734 patients whose radiation therapy was disrupted by a hurricane sometime between 2004 and 2014 and compared them to 1,734 similar patients who had uninterrupted treatment.

When hurricanes interrupted radiation, patients survived an average of 29 months after their diagnosis, compared with 31 months for people without disruptions.

“This is the first study to empirically evaluate the impact of natural disasters on cancer survival,” said Leticia Nogueira, lead author of the study and a researcher at the American Cancer Society in Atlanta.

Survival odds were long for everyone in the study.

Researchers followed half of the patients for at least 15 months. During the study, 1,408 patients with treatment interrupted by hurricanes died, as did 1,331 patients who were unaffected by natural disasters.

Five-year survival rates were 14.5% for patients whose radiation got interrupted during hurricanes and 15.4% for other patients in the study, researchers estimated.

Overall, patients were 19% more likely to die during the study when radiation got disrupted by hurricanes than when treatment continued uninterrupted.

The disaster declarations for hurricanes during the study lasted from 1 to 69 days. The risk of death during the study increased with the length of disaster declarations, rising to 27% for disasters lasting 27 days.

The study wasn’t designed to prove whether or how hurricanes directly impact survival with lung cancer. Another limitation is that searchers lacked data on factors that might independently impact survival outcomes including patients’ smoking history, treatment side effects, and the reasons for or exact dates of treatment breaks.

Still, the differences in survival outcomes can and should be prevented, the study team writes.

“Hurricanes can be predicted and cancer patients should be included in disaster mitigation planning,” Nogueira said by email.

“Patients undergoing daily radiation treatment should be identified before a hurricane disaster, treatment should be transferred to a different facility, and insurance out-of-network charges should be eliminated,” Nogueira added.

When hurricane warnings come, patients who haven’t started radiation should, when possible, start care at a facility outside of the hurricane’s path, said Dr. Richard Cassidy, a radiation oncologist with Cancer Specialists of North Florida in Jacksonville. And patients already in treatment should have their care transferred.

“Physicians and other medical personnel must be accommodating in crises and expedite any radiation planning and other factors to ensure as minimal delay of care as feasible,” Cassidy, who wasn’t involved in the study, said by email. “Working in a community cancer center in an area prone to hurricane impact, we are constantly refining and planning for contingencies in the event of a disaster that leads to an extended loss of power or ability of our radiotherapy clinics to operate.”

As extreme weather becomes more common, this type of planning takes on new urgency, said Asal Johnson, a public health research at Stetson University in DeLand, Florida, who wasn’t involved in the study.

“The impacts of climate change and related extreme weather events extend to cancer patients with possible serious consequences,” Johnson said by email. “It is important for cancer treatment facilities to have a system in place during hurricane seasons and communicate to patients what could be done if the facility is forced to close down.”

SOURCE: JAMA, online July 16, 2019.