Natural Disasters and Cancer Care - Cancer Therapy Advisor

The recent wildfires in Los Angeles are just the latest in a series of natural disasters that have disrupted cancer care.1-5 As these disasters become more and more common, experts are recommending that cancer centers and other health care facilities take steps to prevent or reduce disruptions in care and lower risks for patients.

Climate change is increasing the frequency and ferocity of extreme weather events and natural disasters around the world.6-8 As greenhouse gas emissions accumulate in the atmosphere, trapping heat, global temperatures rise.6,7 This alters water cycles, changes weather patterns, and intensifies extreme weather events. According to the World Meteorological Organization, the number of disasters related to a weather, climate, or water hazard increased 5-fold between 1970 and 2019.8

Cancer patients are particularly at risk during and after natural disasters, as disasters can impede access to cancer treatment.2-5 When health care facilities close or truncate clinical operations in anticipation of, during, and after a disaster, care is delayed. Prolonged power outages can disrupt operations in the short-term, and disasters can damage or destroy health care facilities, disrupting care for weeks, months, or even years. Supply chains can be disrupted as well, causing shortages of critical supplies.

“If power or phone service is disrupted, even contacting the clinic to find out if they are open can be difficult,” said Julie R. Gralow, MD, chief medical officer of the American Society of Clinical Oncology (ASCO). “In the recent flooding due to Hurricane Helene in North Carolina, access to water was an issue well after electricity was restored. For a while, only short infusions were scheduled, since there were no restroom facilities available.”

Even if health care facilities are up and running with adequate supplies, patients may be unable to travel after a natural disaster, said Matthew Berkheiser, associate vice president for Environmental Health & Safety, Sustainability, and Emergency Management at the University of Texas MD Anderson Cancer Center in Houston.

“If they can’t get to the hospital for treatment or an appointment, they may miss out on a scheduled treatment,” Berkheiser said.

These disruptions in care have been linked to a higher risk of death among cancer patients.2,9-12 Studies have shown a higher risk of death among cancer patients who have experienced flooding, hurricanes, wildfires, and other natural disasters.

Experts recommend that health care providers first determine what they will need if a disaster occurs, such as backup power, water, and critical supplies. Providers should make decisions about care interruption and devise communication policies. They should also determine the roles of various teams and set a chain of command. Once emergency plans are place, they should be reviewed regularly, particularly after a disaster.

Berkheiser noted that hospitals accredited by The Joint Commission are required to assess their risks of specific hazards, known as hazard vulnerability assessments.

“Hospitals use this process to determine what they need to plan for, including backup power, water, and food, and other factors based on their highest-ranked risks,” he explained.

Emergency response plans should include “decision points on service interruption, downtime processes, communication policies, and facility and supply chain support,” advised Kelly Batista, executive administrator of cancer services at University of Florida Health in Gainesville. “This plan should be reviewed regularly, ensuring all team members are aware of the systems in place and their roles or responsibilities in case of a disaster.”

Emergency response plans should be reviewed and updated every 6-12 months, according to Tena Messer, executive vice president of operations at the American Oncology Network in Asheville, North Carolina.

“Annual competency and mock scenarios are key to staff education and confidence in managing and responding to emergent disaster events,” Messer added.

Messer and other experts noted that disaster planning and response are inherently multidisciplinary, all-hands-on-deck processes. A facility’s emergency operations managers typically take the lead in planning and responses, but clinical teams, pharmacy operations, facility management, and communications teams must all be involved.

A clear chain of command and role-specific checklists are key to effective planning, Dr Gralow said.

“Whether it’s a natural disaster, drug or IV fluid shortage, or a pandemic infectious outbreak, all hospitals and clinics should have a predefined disaster response team with a designated command center and protocols clearly outlined,” Dr Gralow said.

After disasters are over, MD Anderson conducts “after-action reviews” to identify what lessons were learned and how to modify disaster preparation plans for future events, Berkheiser said.

Experts recommend that health care facilities stockpile crucial supplies, take steps to keep key buildings open, prioritize the use of emergency power, and protect and preserve medical records.

Modified operations plans should focus on keeping key buildings operating, with enough staff on site, Berkheiser said. Priority one is to resume treatment as quickly as possible for the most critically ill patients, he added.

“We would like all health care buildings to have emergency power and water and other backup utilities, [but] because that is not always feasible, we tend to shelter in place or ride it out in the most secure buildings,” Berkheiser said.

“We place most of our critical equipment on emergency power,” he continued. “We don’t want to store critical documents or equipment on the floor in the event of rising water. If we have locations at the hospital with critical equipment, we can and have installed water-leak-detection equipment above those spaces if we are concerned about an internal leak.”

Medical equipment should be plugged into a generator or battery-backed electrical source, Messer said. That’s especially important for continuous patient-monitoring equipment and refrigerators for storing chemotherapy agents.

“Most medical facilities primarily utilize electronic medical records,” Messer added. “Ensuring continuous backup and secure off-site server redundancy or cloud storage will allow preservation of medical records.”

Stockpiling supplies ahead of a disaster is also important, according to Martin Palmeri, MD, of the Messino Cancer Centers in Asheville, North Carolina. He noted that facilities that did not stockpile supplies in advance of Hurricane Helene could not open for 2 weeks after the storm hit.

Experts emphasize the importance of communication before, during, and after a disaster. They recommend that health care facilities ensure contact information is up to date, including addresses, phone numbers, and email addresses for patients and staff as well as contact information for other local health care facilities and government agencies.

“All care providers should prioritize communication with their patients in preparing for a storm,” Batista said. “For example, what is the plan if an area needs to evacuate, are there medical resources available in their community for specialty care, will the clinic close for a period of time, and when will services anticipate being resumed? If there is advanced notice, centers may communicate with patients via patient portal messages or direct calls for those who have scheduled visits.”

“We work with our communications team to craft messages to our patients that we are preparing for the storm, [and] we will provide them status updates through social media channels and other pathways,” Berkheiser said. “If the hospital has a way to text patients information, that is important as well. One thing we learned from [2024 Hurricane] Beryl with all the outages is that we need to set a target resume operations date and time and work toward that as best we can. If the date is pushed out, then we would have to communicate that.”

Berkheiser advised that health care facilities should communicate and collaborate with one another and with government agencies before, during, and after a disaster.

“We work with each other when we have no disasters going on so we are not strangers to each other and can provide support to each other when appropriate,” he said. “We work with our local Southeast Texas Regional Advisory Council and the Regional Hospital Preparedness Council on drills, plans, and support before, during, and after an incident. We also work with local hospitals to support each other. MD Anderson has a routine meeting with the City of Houston to discuss water plans and projects to help build resilience in our water supply.”

Dr Gralow noted that “ASCO has developed a crisis response framework that includes reaching out to our members in affected areas and connecting them by creating a space on our website to post which clinics are open and accepting patients and which are closed.”

Dr Palmeri said health care providers should consider obtaining satellite phones, which can be used when other phone services and internet are not working.

“One of the challenges during Hurricane Helene was the complete breakdown of infrastructure and communication,” Dr Palmeri said. “Most of the region did not have cell phone service, internet, or power for 14 days. The main source of information for western North Carolina for 7 days was the radio.”

Experts recommend that patients make their own emergency plans, stockpile needed supplies, and take steps to protect medications, medical equipment, and medical records.

Patients should be encouraged to do informal hazard vulnerability assessments of their own, anticipating local natural disaster risks and the reliability of their neighborhood and home electrical supplies, Berkheiser said. If possible, patients should ensure they have access to a generator and know how to safely operate it.

Patients relying on life-preserving medical devices should alert their electric companies about their medical vulnerability so their homes are prioritized during recovery operations, Messer said. These patients should also notify their local emergency response agencies about their situation and request proactive wellness checks during a disaster and recovery.

Patients should have checklists outlining their needs and sheets that list emergency contact information, Berkheiser said. Planning ahead can help them identify transportation options as well.

Berkheiser recalled that, during Hurricane Harvey in 2017, MD Anderson patients drove through high waters to access care, and one patient had to be placed on an inner tube to float to the cancer center. (The main MD Anderson campus installed flood gates 20 years ago, but, during Hurricane Harvey, water still entered the buildings due to sewer backups.)

Patients should also ensure that they have backup supplies and protect important documents in waterproof bags or containers, experts advise.

“When possible, patients should have a minimum of 1 week of backup supplies,” Messer said. “Patients with oxygen concentrators should have a manual or portable backup source of oxygen to sustain them during a power outage. Patients receiving continuous IV therapies via ambulatory pumps need proactive education and reference resources to contact for support.”

Patients should also keep medication logs, with drug names and doses, in waterproof bags or containers in case pharmacy or medical records are not available.13 Patients should be encouraged to seek care outside the disaster area if their home facility is not operational and if travel is possible.

One clear lesson from recent natural disasters is that the time to prepare is now, experts agree. No one should wait for hurricane season or an approaching wildfire to ensure that emergency response plans are up to date.

Disclosures: Batista, Berkheiser, Messer, and Dr Gralow said they have no financial disclosures. Dr Palmeri disclosed relationships with Rigel, Johnson & Johnson/Janssen, Karyopharm Therapeutics, Agenus, Allergan, AON, BeyondSpring Pharmaceuticals, Bristol-Myers Squibb, Carolina BioOncology Institute, Corvus Pharmaceuticals, Editas Medicine, Guardant Health, Merck, Natera, Novartis, Novacure, Pfizer, Rafael, SGMO, TGTX, BioCytics, and VieCure.

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Bryant Furlow is a contract medical journalist for the Haymarket Medical Network. He holds a bachelor of science in biology (summa cum laude) from the University of New Mexico. He covers radiation oncology, immunotherapy, tumor biology, clinical research, and health care policy. Prior to becoming a contributor to Haymarket Media in 2010, Bryant was a newspaper reporter in New Mexico, where he won awards for public health and investigative journalism. He also reports for The Lancet Oncology news desk.