According to results of a retrospective study published in JAMA, disruption of radiotherapy delivery due to a declared hurricane disaster was associated with a decrease in overall survival (OS) of patients with locally-advanced non-small cell lung cancer (NSCLC).

Interruption of oncology care by natural disasters, such as hurricanes, has the potential to negatively impact patient outcomes. In particular, patients receiving radiotherapy for the treatment of NSCLC may be particularly vulnerable in the event of a natural disaster, as even short delays in treatment delivery have been shown to be associated with survival detriments.

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This retrospective study included patients with nonoperable locally advanced NSCLC treated with definitive radiotherapy between 2004 and 2014 who were included in the National Cancer Database.  

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Of this group, 1934 (ie, exposed) and 129,080 (ie, nonexposed) patients received radiotherapy during a hurricane disaster and in the absence of an extreme weather event, respectively. The study group included 1734 individuals from the exposed subgroup matched with 1734 individuals from the subgroup of unexposed patients with respect to treatment facility, month of treatment initiation, sex, age, disease stage, lymph node status, zip code of residence, and level of income.

Following a median observation time of 15 months, the respective number of deaths, mean survival time, and estimated 5-year survival rate for the exposed versus the unexposed subgroups were 1408 versus 1331; 29 months versus 31 months; and 14.5% versus 15.4%. 

The duration of radiotherapy delivery was significantly longer for patients receiving treatment during a hurricane disaster (66.9 days vs 46.2 days; P <.001). Furthermore, OS adjusted for patient-specific factors was significantly lower in the exposed versus the unexposed group (hazard ratio [HR), 1.19; 95% CI, 1.07-1.32; P =.001), and the relative risk of death increased with hurricane disaster duration.

Some of the study limitations mentioned by the study authors included the absence of information related to patient smoking history, performance status, and treatment-related toxicity, as well as other factors. 

In their concluding remarks, the study authors opined that “strategies for identifying patients, arranging for transferring treatment, and eliminating patient out-of-network insurance charges should be considered in disaster mitigation planning.”


Nogueira LM, Sahar L, Efstathiou JA, et al. Association between declared hurricane disasters and survival of patients with lung cancer undergoing radiation treatment. .JAMA. 2019;322:269-271.