Hurricanes Tied to Poorer Outcomes in Patients With NSCLC Receiving Radiotherapy

A recent study shows that the declaration of a hurricane during administration of radiotherapy for locally advanced non–small-cell lung cancer (NSCLC) is associated with worse overall survival for the patient, with longer declarations of the natural disaster tied to even worse survival (JAMA. 2019;322[3]:269-271).

Lead investigator Leticia M. Nogueira, PhD, MPH, Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Burbank, California, spoke with Oncology Learning Network about the significance of these findings and what they mean for patients with cancer receiving radiotherapy.

What existing data led you and your co-investigators to conduct this research?

We know that natural disasters can have a devastating impact on the physical, social, and economic infrastructure of communities and interrupt the provision of medical services.

Radiation therapy is a potentially life saving therapy that is particularly vulnerable to the impact of hurricanes because it depends on electricity, the presence of specialized teams, and treatment breaks as short as 2 days have been shown to impact survival.

Ours was the first study to empirically evaluate the impact of hurricanes on survival of cancer patients undergoing radiation treatment.

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

We found that patients who were impacted by a hurricane while undergoing radiation treatment for non-operable locally advanced NSCLC had worse overall survival than patients who completed treatment in the absence of any disasters. The longer the disaster declaration, the worse the survival of these patients.

What are the possible real-world applications of these findings in clinical practice?

Cancer patients should be considered a vulnerable population during disasters. In the article, we recommend that patients undergoing daily radiation treatment for aggressive tumors be identified before a hurricane, treatment should be transferred to a different facility, and insurance companies should eliminate out of network charges during disasters.

Do you and your co-investigators intend to expand upon this research?

Yes, we are currently evaluating the impact of other types of natural disasters on other cancers and treatment modalities.