A Mixed Methods Study to Explore the Effect of Hurricanes Irma and Maria on Cancer Care in Puerto Rico

探索飓风艾尔玛和玛丽亚对波多黎各癌症护理影响的混合方法研究

• 批准号: 9788362
• 负责人: Vivian Colon
• 金额: $ 15.17万
• 依托单位: COMPREHENSIVE CANCER CENTER/ UNIV/PR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-19 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9788362
• 关键词: Acute; Adopted; Affect; Aftercare; American; Americas; Area; Behavioral Model; Cancer Burden; Cancer Patient; Caribbean region; Caring; Certification; Chronic; Chronic Disease; Collaborations; Colorectal Cancer; Communicable Diseases; Communication; Communities; Comprehensive Cancer Center; Development; Diagnosis; Disaster Planning; Disasters; Earthquakes; Educational Materials; Effectiveness; Emergency Situation; Ensure; Environmental Risk Factor; Event; Fatigue; Focus Groups; Future; Goals; Gold; Government; Grant; Health; Health Personnel; Health Professional; Health Services Accessibility; Healthcare Systems; Hemorrhage; Hurricane; Hygiene; Immune system; Immunization; Incidence; Individual; Infection Control; Injury; Interruption; Interview; Island; Japan; Malignant Neoplasms; Medical; Mental Health; Methods; Morbidity - disease rate; Natural Disasters; Outcome; Patient-Focused Outcomes; Patients; Physician Executives; Policies; Population Sciences; Preparation; Prevalence; Procedures; Public Health; Puerto Rico; Quality of life; Recommendation; Regimen; Registries; Reporting; Research; Research Training; Resources; Risk; Safety; Sanitation; Series; Services; Surveys; Survivors; Telephone; Time; Universities; Water; active method; base; cancer care; cancer diagnosis; cancer health disparity; cancer therapy; care delivery; care providers; chemotherapy; colon cancer patients; colorectal cancer treatment; contextual factors; cost; economic cost; emergency service responder; epidemiology study; experience; follow-up; hazard; health care model; health care service utilization; high risk; improved; infection risk; informant; malignant breast neoplasm; mortality; neoplasm registry; survivorship; treatment planning; tumor

6. Project Summary/Abstract On September 2017, Hurricanes Irma and Maria devastated the Caribbean region, particularly the US territory of Puerto Rico (PR) causing widespread destruction and resulting in massive resource losses and economics costs. Critical acute issues caused by this catastrophe mirrored those caused by other disasters worldwide. Health-related issues include problems with sanitation and hygiene, water safety, infection control, immunizations, and access to care. Historically, studies in the aftermath of hurricanes and other natural disasters has focused on environmental risk factors, infectious diseases, physical hazards and mental health. Nonetheless, despite of the burden of cancer worldwide and the exacerbation of chronic diseases in the aftermath of natural disasters, few studies have assessed the impact of natural disasters on cancer, especially those on active treatment, which can have weakened immune systems and may be at higher risk for infections, bleeding, fatigue, and injury. Moreover, it remains uncertain the impact of natural disasters on among cancer patients especially those with breast and colorectal cancer, two of the most common cancers for both incidence and mortality in PR. Breast and colorectal cancer treatment require a series of coordinated services that are susceptible to a catastrophic event. Studying the effects of Hurricanes Irma and Maria on cancer treatment is relevant and of prominent importance for public health since it will have significant consequences to the health care system, since delay in cancer treatment might result in a poorer quality of life, spreading of the tumor, the need for more extensive therapy and ultimately poorer survival. The overall goal of this study is to employ a multilevel mixed-methods approach to identify individual and contextual factors leading to disruption and continuation in cancer care in the aftermath of this unprecedented events. We will collaborate with the the PR Central Cancer Registry, a North American Association of Central Cancer Registries (NAACCR’s) Gold Certificated registry, and one of the oldest registries in America, to: (1) identify barriers and facilitators related to disruption and continuation in cancer care in the aftermath of Hurricanes Irma and Maria through key informants interviews and focus groups with breast and colorectal cancer patients, and (2) evaluate factors associated with cancer care disruption in the aftermath of Hurricanes Irma and Maria among 600 breast and colorectal cancer patients using a telephone-based interview. If granted, this project will provide the opportunity to collaborate with national experts in the field of disasters and health, will serve to inform via an academic-community forum to governmental, professional, community-based and humanitarian organization in the island, as well as emergency responders and clinicians how best to support and potentially mitigate the burden of cancer patients on treatment after a future major natural disaster.

6. 项目总结/摘要 2017 年 9 月，飓风艾尔玛和玛丽亚摧毁了加勒比地区，特别是美国领土 波多黎各 (PR) 造成大面积破坏并导致大量资源损失和经济损失 成本。这场灾难造成的严重问题与世界范围内其他灾难造成的问题如出一辙。 与健康相关的问题包括环境卫生和个人卫生、水安全、感染控制、 免疫接种和获得护理的机会。从历史上看，飓风和其他自然灾害过后的研究 灾害的重点是环境风险因素、传染病、身体危害和心理健康。 尽管如此，尽管全世界范围内的癌症负担和慢性病的恶化 自然灾害发生后，很少有研究评估自然灾害对癌症的影响，尤其是 那些正在积极治疗的人，其免疫系统可能会减弱，并且可能面临更高的感染风险， 出血、疲劳和受伤。此外，自然灾害对癌症的影响仍不确定 患者，尤其是患有乳腺癌和结直肠癌的患者，这两种癌症都是最常见的癌症 PR 的发生率和死亡率。乳腺癌和结直肠癌的治疗需要一系列协调服务 容易遭受灾难性事件的影响。研究飓风艾尔玛和玛丽亚对癌症的影响 治疗对于公共卫生具有重要意义，因为它会产生重大后果 医疗保健系统，因为延迟癌症治疗可能会导致生活质量下降，传播 肿瘤，需要更广泛的治疗，最终导致较差的生存率。本研究的总体目标是 采用多层次混合方法来识别导致 这一史无前例的事件发生后，癌症治疗的中断和继续。我们将合作 与北美中央癌症登记协会 PR 中央癌症登记处合作 （NAACCR 的）金牌认证注册机构，也是美国最古老的注册机构之一，旨在：(1) 识别障碍并 与飓风“艾尔玛”和“玛丽亚”后癌症护理的中断和继续有关的促进者 通过对乳腺癌和结直肠癌患者进行关键知情人访谈和焦点小组讨论，以及 (2) 评估飓风艾尔玛和玛丽亚后与癌症护理中断相关的因素 通过电话采访 600 名乳腺癌和结直肠癌患者。如果获得批准，该项目将提供 与灾害和卫生领域的国家专家合作的机会，将有助于通过 为政府、专业、社区和人道主义组织举办的学术界论坛 岛上以及紧急救援人员和临床医生如何最好地支持并可能减轻影响 未来发生重大自然灾害后癌症患者的治疗负担。