In quick succession, Hurricanes Harvey, Irma, and Maria hit the Texas gulf coast, Florida, Puerto Rico, and other Caribbean islands. The storms and ensuing flooding briefly shut down the University of Texas MD Anderson Cancer Center campus in Houston and several cancer centers in Florida.

But hardest hit — by far — was Puerto Rico.

“The island is totally devastated,” Fernando Cabanillas, MD, medical director of the cancer center at Auxilio Mutuo Hospital in San Juan, told Cancer Therapy Advisor. “If you were not aware that a category 5 hurricane had crossed through the island, you would easily think a nuclear bomb had been dropped.”

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Oncologists and patients on the island have faced numerous challenges in Hurricane Maria’s “totally chaotic” aftermath, Dr Cabanillas said.

“Patients are not able to come to their appointments for several reasons. Some are stuck in their towns with no way to get out. Some live in small towns in the mountains where bridges over rivers have been washed away. Others don’t have gasoline to drive to their appointments.”

Without functioning cell towers in much of the island, furthermore, cancer centers and patients are unable to communicate.

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“We don’t have a way of telling how many patients will show up for their appointments,” Dr Cabanillas noted. “Some drop in without an appointment while others never show up at all.”

Before Hurricane Maria, approximately 600 patients a day were treated for cancer in Puerto Rico. Since the storm, more than 90% of patients have missed treatments or seen treatment delays.

Chemotherapy drug supplies have been “problematic” because of delivery problems, causing additional treatment delays, Dr Cabanillas added.

“Many oncologists don’t have enough diesel fuel to run generators and are keeping chemotherapy drugs refrigerated at home,” said Michael Diaz, MD, of the Florida Cancer Specialists & Research Institute in St Petersburgh.

Chemotherapy drugs at other clinics among at least 75 facilities that offer cancer care on the island have been lost because of power and refrigeration failures, he added. Some cancer centers have not received replacement drug deliveries.

“Radiotherapy cannot run off generators — they don’t provide the flat, continuous power needed,” Dr Diaz said. “Operating rooms are not usable because of flooding and damage — they’re not suitable, don’t meet the criteria for performing surgeries.”

Pathology labs face similar challenges, with diesel tanks running low on fuel, endangering “months’ worth” of laboratory chemicals.

“Everybody is struggling just to get clean water,” Dr Diaz said.