Abstract D072: Challenges providing gynecologic cancer care for women in Puerto Rico after the impact of Hurricanes Irma and Maria: Findings from key informant interviews
Authors: García-Camacho Sandra I. , Rivera Mirza , Calo William , Mendez Pablo , Tortolero-Luna Guillermo , Bernhardt-Utz Yanina , Diaz-Quiñones Astrid , Gomez-Vargas Vanessa Patricia , Umpierre-Catinchi Sharee , DaLuz-Santana Istoni , Ortiz Ana 
Published: September 2020

Abstract
Introduction: Cancer patients are among the most vulnerable populations in the aftermath of natural disasters. Proper delivery and continuity of cancer care is a top priority of medical management after a disaster. On September 2017, Hurricanes Irma and María impacted Puerto Rico (PR), causing major disruption in essential services. Using key informant (KI) interviews, this study documents the experiences and responses of providers/organizations involved in the delivery of gynecologic oncology care in PR. Methods: We conducted 23 KI interviews from organizations in different parts of the island. KIs included providers (gynecologist oncologists, hematologist oncologists, surgeons, radiologists, oncologists, obstetrics and gynecologists), nonprofit organizations (vice-presidents and personnel of the American Cancer Society [ACS] of PR), cancer care facilities (vice-presidents and personnel of public and private hospitals and clinics), and government agencies (Auxiliary Secretary of the PR Department of Health and Government personnel). The interviews addressed problems encountered in their clinics/organizations in the aftermath of the hurricanes, perceived stressors and risks of patients, and recommendations for future preparedness efforts. Results: All clinics/organizations took some preparedness measures but did not have an updated emergency protocol to follow. Most of the physicians prepared by protecting the clinics and calling patients to reschedule surgeries and follow-up visits. All KIs experienced in their clinics/organizations disruption of telecommunications; potable water, and electric power after the hurricanes. They confronted challenges in finding essential supplies like fuel for electricity generators, oxygen, and chemotherapy drugs. The oncologists implemented an emergency collaboration network to share services, medical supplies, and other essential medications needed for the care of patients. Some of them expressed that treatments, such as radiotherapy, were delayed because the equipment required a stable source of energy and cooling temperatures. Organizations such the ACS helped moved patients to the United States so that they did not have to interrupt their cancer treatment; many of these patients had to come back as they were not able to get services there. Even the largest hospitals in PR, including those in the most populous cities, confronted serious problems of communication with the government and FEMA. Conclusion: Although interruptions and delays in services occurred, all the KIs interviewed mentioned to have given the best effort to try to prevent patients from interrupting their treatment. One of the biggest obstacles to provide oncology treatment was the lack of effective communication between agencies. These results guided the topic areas that will be assessed in the subsequent quantitative phase of this NCI sponsored project, and the development of a disaster management plan for cancer patients in PR. NCI Grant #R21CA239457.
Citation Format: Sandra I. García-Camacho, Mirza Rivera, William Calo, Pablo Mendez, Guillermo Tortolero-Luna, Yanina Bernhardt-Utz, Astrid Diaz-Quiñones, Vanessa Patricia Gomez-Vargas, Sharee Umpierre-Catinchi, Istoni DaLuz-Santana, Ana Ortiz. Challenges providing gynecologic cancer care for women in Puerto Rico after the impact of Hurricanes Irma and Maria: Findings from key informant interviews [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D072.