||5R21CA239457-02 Interpret this number
||Comprehensive Cancer Center/ Univ/Pr
||Impact of Hurricane-Related Stressors and Responses on Oncology Care and Health Outcomes of Women with Gynecologic Cancers From Puerto Rico and Us Virgin Islands
Cancer is the leading cause of death in Puerto Rico (PR) and the United States Virgin Islands (USVI).
Gynecologic (GYN) cancers represent more than 15% of all cancers diagnosed in women in PR. GYN cancer
data from USVI is unknown as they recently created a cancer registry. Cancer has been described as one of
the conditions of top medical management priority after a natural disaster. In particular, cancer patients are
among the people with the greatest risk of death and complications after a disaster, as health care
interruptions can negatively affect their health outcomes. On September 2017 Hurricanes Irma and María
affected PR and USVI, causing all the population to experience major disruptions in essential services (e.g.
potable water and electric power, health services, telecommunications, and transportation) and potential
environmental health issues (e.g. water sanitation, contaminant exposure, vector borne diseases, and food
hygiene). Research has evidenced that extreme events lead to disruptions in health care systems and can
have a direct impact in health status of populations. The impact of these hurricanes on oncology care and
health outcomes of GYN cancer patients has yet to be documented, particularly knowing that access to care
prior to the hurricanes existed, as only 5 trained GYN oncologists provide services in PR and none in USVI,
and patients from USVI relocate for oncologic care to the continental US and PR. To address this gap, the
proposed study will focus on oncology care and health outcomes of women with GYN cancer from PR and
USVI who receive health services in PR and will use a mixed-methods approach to answer the proposed study
aims: 1) determine the psychosocial and environmental stressors and 2) the multi-level responses that women
with GYN cancers experienced in the aftermath of hurricanes Irma and María, and 3) determine the impact of
such stressors and multi-level responses on oncology care and health outcomes among women with GYN
cancers. Using a qualitative assessment (focus groups and key-informant interviews), we will document the
stressors, responses, and experiences of patients and providers/organizations involved in the receipt and
delivery of GYN oncology medical services in PR, respectively. Afterwards, a retrospective cohort study design
will be used to quantitatively evaluate the impact of stressors and multilevel responses on oncology care and
health outcomes in a clinic-based, two-way stratified random sample of 400 women with GYN cancer. The
clinics where GYN oncologists provide care in PR will collaborate in the study. Data collection procedures will
include an interviewer administered questionnaire, assessment of susceptibility to hurricane-related physical
hazards, and medical record review. Bayesian spatio-temporal models with the inclusion of hierarchical
structures will be used to capture temporal and spatial trends of our outcomes, given our predictors variables,
in several levels and interactions. Study results will be disseminated and used to generate recommendations
and guidelines for future disaster planning and response through the creation of a Dissemination Board.
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