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.项目摘要/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)造成大范围破坏，造成大量资源损失和经济损失 成本。这场灾难造成的严重尖锐问题与世界各地其他灾难造成的问题如出一辙。 与健康有关的问题包括卫生和个人卫生、水安全、感染控制、 免疫接种和获得护理的机会。从历史上看，对飓风和其他自然事件的研究 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，尽管世界范围内癌症的负担和慢性病的恶化， 关于自然灾害的后果，很少有研究评估自然灾害对癌症的影响，特别是 那些正在接受积极治疗的人，可能会削弱免疫系统，并可能面临更高的感染风险， 流血、疲劳和受伤。此外，自然灾害对癌症患者的影响仍不确定。 患者，特别是乳腺癌和结直肠癌，这是两种最常见的癌症 PR的发病率和死亡率。乳腺癌和结直肠癌的治疗需要一系列协调的服务 它们很容易受到灾难性事件的影响。飓风伊尔玛和玛丽亚对癌症影响的研究 治疗是相关的，对公共卫生具有突出的重要性，因为它将产生重大后果 对于保健系统来说，由于癌症治疗的延误可能会导致较差的生活质量，因此 肿瘤，需要更广泛的治疗，最终存活率更低。这项研究的总体目标是 采用多层次混合方法来确定导致以下问题的个人和背景因素 在这一史无前例的事件之后，癌症护理的中断和继续。我们将合作 与北美中央癌症登记协会PR中央癌症登记中心合作 (全国有色人种协进会)金牌认证注册处，是美国最古老的注册处之一，以：(1)识别障碍和 飓风伊尔玛和玛丽亚过后，与中断和继续癌症护理有关的促进者 通过与乳腺癌和结直肠癌患者的关键线人访谈和焦点小组，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接受了电话采访。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 政府、专业、社区和人道主义组织的学术-社区论坛 以及急救人员和临床医生如何最好地支持和潜在地缓解 未来发生重大自然灾害后，癌症患者的治疗负担。