Our finding that individuals diagnosed with cancer who were exposed to Hurricane Katrina have worse long-term survival is supported by a recent systematic review showing that disasters interrupt the continuity of oncology care.1 It is likely that many individuals in our study experienced a disruption in access to healthcare that ultimately affected outcomes. Indeed, treatment disruptions as short as one week have been associated with cancer-related mortality.4, 5
Persistent inequalities affecting cancer progression are well-known to exist in the New Orleans area. Although we matched on key characteristics and account for others in our statistical models, we cannot fully rule out potential residual confounding affecting our results, and the association found between exposure and survival may not be causal, as there could be other confounding variables. However, these adjustments showed consistent findings, albeit with somewhat greater imprecision in the measurement of the confidence interval. Our study examined one single large-scale disaster and found some evidence of this disaster affecting long-term survival. Effects may be different for other health conditions and populations.
Nevertheless, our findings suggest that adverse effects for individuals with cancer may persist well after a disaster is over. There is an urgent need for research investigating the long-term effects of disasters on population health. Indeed, a recent report by the National Academy of Medicine called for the identification of gaps in healthcare system disaster response in order to better promote models of recovery.6 To this end, efforts should be extended beyond the acute response period to consider the health needs of those with serious chronic conditions.