Cancer care during natural disasters.

W hen natural disasters occur, everyone is focused on survival. But for cancer patients, this challenge is all the more arduous — because hospitals and other health care infrastructures may be destroyed, wiping out their medical records, and both physicians and patients may be forced to flee. “Cancer patients are especially susceptible to the disruptions that natural disasters can cause,” said Anna Pou, M.D., professor in the department of otolaryngology – head and neck surgery at the Louisiana State University Health Sciences Center in New Orleans. “Lapses in treatment can have an effect on treatment outcomes.” Pou, who experienced Hurricane Katrina in August 2005, said communication was the biggest challenge after the hurricane hit. “In cancer treatment, contact with colleagues is a very important part of the process,” she said. “Proper treatment involves working with pathologists, radiation and medical oncologists, surgeons, and other services.” Hospitals were destroyed, and paper records were underwater. Contacting patients proved to be mostly useless, because phone numbers either were disconnected or rang constantly because no one was home. Cell phone service was spotty at best. Pou ’ s group reassembled quickly in Baton Rouge. They had their physicians together during the week after Katrina and began seeing patients within 2 weeks. “We had patients, but little else,” she said. “We did not have pathology reports, information from medical oncologists on chemotherapy dose, or anything to know how much radiation they had received. Worse, we did not have any way to get it.” Although some patients were prepared and had at least some information with them, most did not. People would show up in Pou ’ s offi ce, saying they had cancer. Many had no idea as to specifi c type of cancer, stage, or how it was being treated. According to Marcello Blaya, M.D., assistant professor of medicine at Tulane, “This meant quite a bit of detective work was needed. Physicians in Louisiana and throughout the U.S. had to track down the information. They weren ’ t always able to fi nd what was needed.” Many physicians were unwilling to blindly give radiation or chemotherapy to patients. And patients who found treatment options faced other concerns. “Cancer care was fragmented across the state,” said Blaya. “They were having their workup done in one place and then the treatment in another.” Although Katrina ’ s widespread devastation may be an outlier among natural disasters, smaller tornados and fl oods disrupt cancer care throughout the country.