The Impact of Hurricane Ian on Cancer Care

Host Dr. John Sweetenham, of the UT Southwestern Harold C. Simmons Comprehensive Cancer Center, and Dr. Eduardo Sotomayor, director of the cancer institute at Tampa General Hospital, discuss the impact of Hurricane Ian on cancer care in Florida, and the importance of disaster preparedness to protect patients and clinicians in regions prone to natural disasters.   TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, the associate director for Clinical Affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center, and host of the ASCO Daily News podcast. Hurricane Ian, a large and destructive Category 4 hurricane, has caused fatalities and widespread damage in Florida after causing huge destruction in Cuba. Communities in the hardest-hit areas have been destroyed, and hospitals across the state have been forced to evacuate patients. Today, I will be speaking with Dr. Eduardo Sotomayor, the director of the Cancer Institute at Tampa General Hospital, about the impact of the hurricane on cancer care. Our full disclosures are available on the transcript of this episode, and disclosures relating to all episodes of the ASCO Daily News podcast are available on our transcripts at asco.org/podcasts. Dr. Sotomayor, thanks for being on the podcast today. Dr. Eduardo Sotomayor: Thank you, John, and the ASCO Daily News Podcast, for having me. Dr. John Sweetenham: To begin with, Dr. Sotomayor, could you tell us a little about how Hurricane Ian impacted cancer care at your institution, and how soon do you think you'll have all of your cancer services restored? Dr. Eduardo Sotomayor: Thank you for the opportunity to talk to you about the effect of Hurricane Ian on the state of Florida. But before we start, I would like to say that our thoughts and our prayers are for those Florida citizens who were severely affected by this hurricane, in particular, our cancer patients and their caregivers. So, Tampa General Hospital is located on Davis Islands. So, we were at high risk for having inundation, major destruction, and disruptions in cancer care if the hurricane hit us directly. We were blessed that at the last minute, the hurricane changed its path. But it's important to emphasize all of the preparation that took place, starting seven days before the potential landfall of the hurricane in the state of Florida. This started at the highest levels of the hospital, with the senior leaders getting together as well as the leaders of the cancer institute. We have different scenarios that we call scenario A, B, and C. So, scenario A was the worst-case scenario that we would have a direct hit, then one or two floors of the cancer institute and the hospital would be under water. So, for that scenario, we knew that we needed to be ready to move cancer care to other facilities that Tampa General has inland in areas called Riverview and Brandon. So, scenario C is the scenario that fortunately for us, was the scenario that we dealt with during the storm. We didn't have a direct hit; we had only minimal damage, and we were able to reopen our doors 48 hours after the storm hit Florida. Important to mention also is that during those 48 hours, there was significant disruption in cancer care. In the inpatient service, we had to decrease the number of inpatients to keep those patients that really needed to be in the hospital. We closed all our outpatient facilities and therefore needed to call every patient to let them know about the cancellation of appointments, but also re-scheduling those appointments for the days after the storm has passed. As I said, again, we were among the lucky cancer centers in the state of Florida, but south of us, there were hospitals and community oncology practices that were severely affected by Hurricane Ian. Dr. John Sweetenham: So, it sounds to some extent, Dr. Sotomayor, as if your institution kind of dodged a bullet, although clearly people south of you were very badly affected. But I'm assuming that there had been some disruptions to care for your patients. Can you comment a little on that, and what you're doing to address the disruptions to care, assuming that you experienced some, even though you didn't take a direct hit. Dr. Eduardo Sotomayor: What we have learned from this experience is that preparation is extremely important. Within 24 hours, we created a command center, an operations team, our logistics team, safety team, and we started canceling those appointments that were not critical. When we knew that the hurricane was coming in our direction, then we had to cancel all of our operations. But then we had meetings twice a day with different members of our team to start making phone calls also regarding cancellation of appointments. And then, as the days passed, we started to adapt our plans and starting calling back patients. What is important, I think a silver lining of the COVID-19 pandemic, has been the availability of telehealth, of easy communication with patients. I think that patients are now savvier with managing telehealth. So, the days after the hurricane hit us, we had some patients that had to come back to receive chemotherapy infusions or radiation, but the large priority of patients were able to manage via telehealth. Dr. John Sweetenham: Yes. Thank you. I know one of the questions that I was going to ask you a little later on was whether the telehealth infrastructure that was developed during the COVID-19 pandemic was helpful in response to the hurricane, and clearly from your comments, it has made it easier in terms of patients' familiarity with the platform and so on. So, that's good to know. Dr. Eduardo Sotomayor: Right. And also, just to add to that is that technology before the COVID-19 pandemic, when we were facing a similar situation. Basically, all our call centers would be closed. So, these days we have technology in which employees or members of our team that were receiving or making phone calls, now can do through through special apps in case the internet goes down or electricity goes down. Still, now there are systems that can allow temporary communication with patients in a timelier way. Dr. John Sweetenham: Yeah, that's very reassuring. The Florida Hospital Association has said that many hospitals are feeling capacity pressure. Can you comment on what the Tampa General Hospital is able to help by perhaps offloading other institutions that were badly damaged in the storm, particularly those in the Southwest of Florida? Dr. Eduardo Sotomayor: Yeah, that's a very important question. I think that when we knew that we would be okay and there would not be a significant impact of the hurricane on our facilities, we changed our course and started calling our partners in the oncology community, private practice groups, Florida Cancer Specialists that have offices and provide cancer care in those areas that were severely affected by the hurricane. We are working together. One of the things that I have learned is that a significant percentage of cancer care is performed in the community. Communities were affected by this hurricane and therefore I think it is important to keep that open communication between academic centers and oncology practice in the community. With reference to your question, Tampa General has six helicopters; it has a command center and as soon as it was safe for our helicopters to travel, they went to these affected areas. There were hospitals near our region that didn't have electricity or water. I am proud of the service provided by Tampa General Hospital to other hospitals and cancer care communities that were severely affected by the hurricane. I think so far, we were able to transfer between 50 to 70 patients who were in critical condition and needed to be removed from those areas that were significantly affected by the hurricane. And I have to say, Tampa General Hospital is just one of the hospitals that responded; all of the hospitals in the state of Florida joined a forces to help our patients in general during these difficult times. Dr. John Sweetenham: Yeah, it's certainly great to hear of the oncology community and healthcare community in general coming together to overcome the challenges for so many of these patients. You know, one of the challenges that occurs to me, which might be an issue for you because of your increased patient volumes, as well as for those centers that are more directly affected by the hurricane, and that's the issue of supply chain and availability of medicines, and particularly chemotherapy and other antineoplastic drugs. Can you comment on whether you are experiencing any supply chain issues with medicines, or whether you're aware of other organizations in the southern part of Florida who are having those challenges at the moment? Dr. Eduardo Sotomayor: So, there are two answers to your question; if we are lucky to be in urban communities, I think that the supply chain was not significantly affected, but the problem has been in the rural communities in Florida. And unfortunately, in addition to the areas near the ocean, including Fort Myers, Naples, and Port Charlotte, the track of the hurricane through Florida affected the rural communities. And in those rural communities the problem was flooding, several trees went down, access in those areas was problematic, and they are still dealing with significant issues in the supply chain. What we are doing as are all the other big centers, is  trying to do our best to either provide those supplies to these affected areas or to transfer some of the patients from those areas to, I would say, urban hospitals that have more capacity. Dr. John Sweetenham: So, this raises, I think, a really important issue. We know that very typically underserved communities are disproportionately impacted when there are natural disasters. And to your point, it's clear that you've seen the potential for significant disruption to rural versus urban communities as a result of the hurricane. Do you have any other thoughts or maybe any other examples of how disproportionate care may have arisen because of the effects on underserved communities? Dr. Eduardo Sotomayor: Even before any natural disasters, rural communities-- and I want to focus on rural communities in the state of Florida because there is a significant number of Floridians that live in rural communities. And if you look at the incidence of cancer and mortality associated with cancer in those rural communities, it is greater than the mortality that occurs in urban areas or big cities. So, number one. And there are several issues; there is transportation, access to care, very few oncology providers in those areas. So, even before the natural disaster that just happened, those communities were significantly disadvantaged. And unfortunately, not only the hurricane affected those rural areas, but now I would say the few organizational capabilities that they have have been further impacted. So therefore, when we think about the impact of the hurricane in the state of Florida, we should also be thinking about our rural communities. They are the ones that are going to take longer, perhaps months, or even a year, to recover from the significant damage that Hurricane Ian has imposed upon those communities. Dr. John Sweetenham: Thanks. Switching gears a little, are you concerned about the disruption of research and clinical trials in parts of Florida in the months ahead? I'm just thinking with issues such as-- you know, initially it will be scheduling of treatments, perhaps the transportation disruption, and so on. Do you see these as being potential threats to clinical trial activity in the state for the coming months, and possibly years? Dr. Eduardo Sotomayor: So again, I think that clinical trials in big centers, in urban areas are going to be able to recover relatively quickly. I mean, for instance, our clinical trials operation is back to normal, and was not affected. So, there is a big community oncology practice in the state of Florida, Florida Cancer Specialists, especially if they have active clinical trials, but they have locations in several of the areas that were significantly affected by the hurricane. So, I think in those areas, it is going to take time to recover. But in my early conversations with our colleagues, Florida Cancer Specialists especially, they're going to be moving some clinical trials operations from those affected areas to areas that are fully functional. But definitely, there is going to be a disruption, yes. And unfortunately, that disruption is going to affect those patients enrolled in clinical trials that live in underserved areas, and in particular, those who live in rural areas because access to transportation is going to be a significant problem for them. Dr. John Sweetenham: Yeah, absolutely. I think is one of the consequences of what the emerging climate changes that we've been seeing over many years now, and certainly, there has been a significant interest in the literature, and indeed, on previous ASCO Daily News podcasts regarding the impact of climate change on cancer care. And perhaps, the most immediate example of that is in terms of disaster preparedness of cancer centers. Certainly, that has been tested for you and for other centers in Florida in the last couple of weeks. How would you assess the readiness of your cancer centers to respond to disasters of this scale? Do you think there are areas of care that you've now learned need more attention, just as a direct consequence of this most recent hurricane? Dr. Eduardo Sotomayor: So, I think it's going to be location-dependent. You know, Florida is a big state. For us and other centers that are in the islands, the surge was probably the major threat for us. I mean, there is a technology now called AquaFence. So basically, there are panels that will help you, to be able to give you time to evacuate or to protect the lower floors of the cancer center of the TGH hospital as a whole. It's called AquaFence. So, we install those panels around the whole hospital, and I think that's one of the technologies. And we are going to see more and more of those technologies to try to protect or minimize the potential damage that a hurricane can cause. I mean, my prediction is that it’s going to be able to support a hurricane category two, three, or even four, but you know, five - time will tell. So, we need to start thinking more about technology, that's in our case. So, there are other cancer centers that are inland in which the problem for them is going to be flooding. So, one lesson that we have learned is, there has been constant communication between all the cancer centers in this region. In the academic institutions, the University of Miami, Florida, us, Moffitt Cancer Center, but also in the community - Florida Cancer Specialists, especially, community oncology practices. And I think that if you ask me, "What would be the next step?" It will be to foster stronger communication, a stronger collaboration that involves also our community oncology practices because as you know, John, most of the cancer care now is happening close to home. Dr. John Sweetenham: Well, thanks for that. I think that's such an important message, and I should add for our listeners that you can find information about disaster resources for care providers and patients on the ASCO website, at: asco.org. Dr. Sotomayor, I just want to thank you again for giving us your time today at what must be a really busy time for you all and would like to wish you and our many colleagues in the region, especially those in the hardest hit areas of southwest Florida, all the best during difficult and uncertain times as they try to recover from the hurricane. Dr. Eduardo Sotomayor: There are so many heroes here - talking about cancer care, you know, oncologists, nurses, APPs, MAs - they left their families at home and they went and they stayed with patients. So, I am proud to say that most of them, they offered to go there. We didn't need to say you, and you, and you. And I want to thank all of those, you know, our colleagues, providers, all the team members in all the hospitals, big, medium size, also small, in the state of Florida, that they left their loved ones to be support and take care of our patients. Dr. John Sweetenham: Certainly heartwarming to hear about that kind of response. And thanks again to you, Dr. Sotomayor. And thank you to our listeners for your time today. If you value the insights that you hear on ASCO Daily News podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement. Follow today’s speakers: Dr. John Sweetenham @JSweetenhamMD Dr. Eduardo Sotomayor Tampa General Cancer Institute   Want more related content? Listen to our podcast on climate change and cancer: Climate Change and Cancer   Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn   Disclosures: Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness Dr. Eduardo Sotomayor: Consulting or Advisory Role: Seattle Genetics, Genentech/Roche, Celgene, Kite Pharma, Bayer, AstraZeneca, Pharmacyclics Speakers' Bureau: Seattle Genetics, Pharmacyclics