Disasters ranging from tsunamis to terrorism seem increasingly prevalent in daily life, affecting the lives of cancer patients and the treatment teams who care for them. A special section of the March 15 International Journal of Radiation Oncology•Biology•Physics (Red Journal) tackles the unique issues involved in providing care during and after a disaster. Reflecting on experiences during recent hurricanes and other catastrophes, radiation oncologists from the U.S. and abroad share their stories, the lessons learned and their advice for others in similar situations.
In an editorial that introduces the collection, we consider what defines a disaster and overview common themes among the articles. We also highlight the important role of radiation oncologists in catastrophic situations: "In times of disaster, we do remain doctors; and so in that spirit, one can highlight the bonds of clinical practice that unite our communities in time of challenge, doing the things we know how to do well. We can anticipate disruptions, determine in advance how to manage interruptions, take in and complete the treatment of those whose cancer care has been cut midway, and advocate to help patients relocate for care or extend the aids needed to restore medical operations."
Several articles examine the issue of unplanned treatment interruptions, considering both how unexpected delays affect patients receiving radiation therapy and how radiation oncologists can compensate for these negative effects. Focusing specifically on locally advanced lung cancer, head and neck cancer and prostate cancer, the authors of these pieces summarize current evidence on how treatment delays undermine tumor control and outline strategies to mitigate this adverse impact, such as adjusting radiation dosing and fractionation following an unanticipated gap in therapy.
The special section also includes case reports of radiation oncologists responding to recent disasters, including years of hurricanes in Houston capped by the category-five Hurricane Harvey and the "triple disaster" of an earthquake, tsunami and subsequent nuclear meltdown in Fukishima, Japan. These recollections emphasize the importance of careful, deliberate planning for crisis situations but also stress that adaptability is essential in a disaster. A commentary on the impact of Hurricane Maria in Puerto Rico, for example, recounts how one center reopened for a single patient in need of care:
"Imagine you are a cancer patient receiving radiation therapy and live at the center of the island, one of the regions most devastated by the hurricane, and you are unable to reach the hospital until 3 weeks after the hurricane. In addition, it will require 3 hours to reach the hospital because of the roads, and when you arrive, the linear accelerators are off and the employees are leaving because they need to drive home while there is sunlight. Imagine the despair of this patient after all she went through only to see that everything was off. Thankfully, in this case, the therapists and physicists at this center turned everything back on and stayed to treat her, putting their own lives in danger by driving home in the pitch black night with no working traffic lights. These are the people that are holding the island up, hardworking people that regardless of the danger or the struggles to obtain gas and food are still providing services to those in need and helping each other."
The collection closes with an article describing efforts by ASTRO and others to prepare communities for a disaster involving mass exposure to radiation, such as the nuclear fallout in Fukishima or a hypothetical "dirty bomb" attack. The review encourages hospitals to develop plans for nuclear/radiological preparedness, as well as teams equipped to implement these plans if needed.
As our editorial concludes, "this edition of the Red Journal was inspired by the sheer accumulation of recent disasters around the world and our acknowledgment that, in a time of climate uncertainty, terrorism, and an aging electrical grid, we are each and all vulnerable. We are presenting this collection not to pass out easy answers but in hopes of starting a conversation about how these events affect our profession and our patients. Sharing experiences and recommendations is a necessary first step on our path to preparation."
What are your experiences with and recommendations for providing care in the face of disaster? In the comments area below, please feel free to share with fellow ASTRO members, physicians and physicists suggestions and tactics that your practice has put into place to prepare for the event of a natural and/or man-made disaster.