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

6.项目概要/摘要 2017年9月，飓风伊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）造成广泛的破坏，并导致大量的资源损失和经济 成本这场灾难造成的严重问题反映了世界各地其他灾害造成的严重问题。 与健康有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。从历史上看，对飓风和其他自然灾害后果的研究 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，尽管世界范围内的癌症负担和慢性疾病的恶化， 在自然灾害之后，很少有研究评估自然灾害对癌症的影响，特别是 那些正在积极治疗的人，免疫系统可能会减弱，感染的风险可能会更高， 流血疲劳和受伤此外，自然灾害对癌症的影响仍然不确定。 尤其是乳腺癌和结直肠癌患者，这是两种最常见的癌症， 乳腺癌和结直肠癌的治疗需要一系列的协调服务 容易受到灾难性事件的影响。研究飓风Irma和Maria对癌症的影响 治疗对公共卫生具有相关性和突出的重要性，因为它将产生重大后果 由于癌症治疗的延误可能导致生活质量下降， 肿瘤，需要更广泛的治疗，最终生存率更低。本研究的总体目标是 采用多层次混合方法的方法，以确定个人和背景因素导致 在这一前所未有的事件之后，癌症护理的中断和持续。我们将合作 PR中央癌症登记处，一个北美中央癌症登记协会， （NAACCR）黄金认证注册中心，也是美国最古老的注册中心之一，旨在：（1）识别障碍， 在飓风伊尔玛和玛丽亚之后，与癌症护理中断和持续有关的促进者 通过与乳腺癌和结直肠癌患者的关键知情人访谈和焦点小组，以及（2） 评估与飓风伊尔玛和玛丽亚之后癌症护理中断相关的因素， 600名乳腺癌和结直肠癌患者使用电话采访。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，将有助于通过一个 为政府、专业、社区和人道主义组织举办学术-社区论坛， 岛上，以及紧急救援人员和临床医生如何最好地支持和潜在地减轻 癌症患者在未来重大自然灾害后的治疗负担。

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.