Abstract PO-109: Key informant assessment to explore barriers and facilitators related to disruption and continuation of cancer care in the aftermath of Hurricanes Irma and Maria
Authors: Soto-Salgado Marievelisse , Ortiz-Ortiz Karen Judith , Cardona Yahisha , Sánchez Yara , Colón-López Vivian 
Published: December 2020

Abstract
Background: Hurricane Maria devastated the Caribbean region, particularly the US territory of Puerto Rico (PR), causing widespread destruction, resulting in massive resource losses and economic costs. It remains uncertain the impact of natural disasters on cancer and how such a disruption will affect access to cancer treatment especially those patients in active cancer treatment. We aimed to understand barriers and facilitators to disruption and continuation in cancer care in the aftermath of hurricanes Irma and Maria in Puerto Rico among multiple levels.
Methods: This study is part of a mixed-methods project which aims to explore the individual and system-level factors related to disruption of cancer. For this analysis, we collected data using in-depth interviews with key informants (KIs) from September 2018 to August 2019. An interview guide was tailored to each key informant’s context, taking into consideration the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to explore different levels of influence on cancer care. A thematic content analysis was performed to identify emergent sub-themes and patterns under each of the domains of influence of the NIMHD framework. Results: We interviewed 48 KIs, including stakeholders from clinical services (e.g., cancer centers), health care providers (e.g., oncologists), humanitarian organizations, community and pathology laboratories, and community pharmacies, among others. Facilitators for continuation to care such as availability or purchase of generators, water tank, and medical supplies (e.g., reagents, laboratory materials) previous to the event were identified. Some institutions and physicians were able to continue their services thanks to new alliances formed with other institutions/organizations after the disaster. All of the KIs mentioned that they restructured their organization regarding change of hours, employee rotations, transfer of operations to other facilities, among others, to continue providing clinical services. Most emergent barriers discussed were lack of local emergency preparedness plans, lack of communication and electricity, avoidance of collaboration between institutions that offer similar services (direct competition), and limited preparation and government protocols; as factors that might have delayed or interrupted clinical services. Among lessons learned, some KIs mentioned the need to develop clinical guidelines for the continuation of treatment after a natural disaster, educate cancer patients on how to prepare for a natural disaster, and offer training on emergency response for major natural disasters to employees of the institutions and organizations. Conclusions: Our data highlights the importance of developing, disseminating, and implementing emergency response plans at individual and system levels to guarantee the continuation of care among cancer patients after a future major natural disaster.
Citation Format: Marievelisse Soto-Salgado, Karen Judith Ortiz-Ortiz, Yahisha Cardona, Yara Sánchez, Vivian Colón-López. Key informant assessment to explore barriers and facilitators related to disruption and continuation of cancer care in the aftermath of Hurricanes Irma and Maria [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-109.