Portal de Periódicos da CAPES

Radiation Therapy in a Time of Disaster

2018; Elsevier BV; Volume: 100; Issue: 4 Linguagem: Inglês

10.1016/j.ijrobp.2017.12.001

1879-355X

Sue S. Yom, Anthony L. Zietman,

Effects of Radiation Exposure

What constitutes a disaster? The United Nations defines it as "a serious disruption of the functioning of a community or a society [exceeding its ability] to cope" and requiring assistance from external sources, perhaps national or international (1United Nations Office for Disaster Risk Reduction2009 UNISDR Terminology on Disaster Risk Reduction. UNISDR, Geneva, Switzerland2009: 9Google Scholar). These bleak features—precipitous social disruption and conditions of extreme dependency and need—separate the vastness and isolation of "disaster" from other relief aid terminologies, such as "hazard," "risk," "emergency," or "epidemic," which are more anticipatory, classificatory, or managerial in nature. Disasters are physical and immediate, based on abrupt and massive loss of or to humans. They are shocking and myth-making in scope—and even when remote from them, we fear this could happen to ourselves or our loved ones. It seems that disasters are becoming a part of our daily landscape. Only recently there have been rapidly successive hurricanes, global warming, enormous earthquakes, tsunamis, and landslides around the world; ethnic and religious terrorism; and a number of regional and possibly enlarging wars. In the pages of the International Journal of Radiation Oncology, Biology, Physics (the Red Journal), features on Lebanon (2Zeidan Y.H. Geara F. Lebanon: An evolving hub for radiation therapy in the Arab world.Int J Radiat Oncol Biol Phys. 2015; 91: 888-891Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar) and Iran (3Kabolizadeh P. Aghili M. Balakhanlou B. A Time for Optimism? The state of radiation oncology in Iran.Int J Radiat Oncol Biol Phys. 2016; 94: 221-227Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar) have portrayed the conditions of radiation therapy in times of paralyzing disruption, and a recent plea from Puerto Rico (4Lopez-Araujo J. Burnett III, O.L. Letter from Puerto Rico: The state of radiation oncology after Maria's landfall.Int J Radiat Oncol Biol Phys. 2017; 99: 1071-1072Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar) described agonizingly inadequate healthcare conditions that remain mostly unaddressed. These events bring into sharp focus the supports and structure needed for cancer care, and particularly our profession of radiation therapy. Furthermore, the ripples of disaster migrate outward over time. In Fukushima, there was the initial experience of the earthquake, tsunami, and nuclear meltdown, but long after the news reporters had left, the abandonment of this fragile community and its health and healthcare continued (5Ozaki A. Tsubokura M. Radiation oncology and related oncology fields in the face of the 2011 "triple disaster" in Fukushima, Japan.Int J Radiat Oncol Biol Phys. 2018; 100: 845-848Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar). As the catastrophe in Puerto Rico develops in the wake of Hurricane Maria and tens of thousands of young people leave the island for good, a full accounting of the impact on those left behind may not be known for years (4Lopez-Araujo J. Burnett III, O.L. Letter from Puerto Rico: The state of radiation oncology after Maria's landfall.Int J Radiat Oncol Biol Phys. 2017; 99: 1071-1072Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 6Perez-Anjudar A. Puerto Rico: After María.Int J Radiat Oncol Biol Phys. 2018; 100: 834-835Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 7Rojasnov R. Escaping Puerto Rico, but not the guilt of fleeing. The New York Times. November 27, 2017:A1.Google Scholar). In times of disaster, we do remain doctors; and so in that spirit, one can highlight the bonds of clinical practice that unite our communities in time of challenge, doing the things we know how to do well—such as managing lung, prostate, and head and neck cancers to the best standards attainable in times of crisis (8Roach M.C. Robinson C.G. Bradley J.D. Natural disasters and the importance of minimizing subsequent radiation therapy interruptions for locally advanced lung cancer.Int J Radiat Oncol Biol Phys. 2018; 100: 836-837Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 9Sandler H. Role of overall treatment time in the management of prostate cancer patients: How to manage unscheduled treatment interruptions.Int J Radiat Oncol Biol Phys. 2018; 100: 841-842Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 10Yom S.S. Harari P.M. When disaster strikes: Mitigating the adverse impact on head and neck cancer patients.Int J Radiat Oncol Biol Phys. 2018; 100: 838-840Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar). We can anticipate disruptions, determine in advance how to manage interruptions, take in and complete the treatment of those whose cancer care has been cut midway, and advocate to help patients relocate for care or extend the aids needed to restore medical operations. Communities, whether built on the profession of radiation therapy or otherwise, bridge the chasms that separate us from the disaster of others. Disaster workers insist that after the suffering fades and electricity is restored, there is a moral imperative for reassessment and installation of preventive interventions (11Zack N. Ethics for Disaster. Rowman & Littlefield, New York2009: 29Google Scholar). In Houston, a city on the Gulf Coast well weathered by hurricanes, initiatives for disaster readiness serve as useful references (12Mireles M. Pino R. Teh B.S. et al.Radiation oncology in the face of natural disaster: The experience of Houston methodist hospital.Int J Radiat Oncol Biol Phys. 2018; 100: 843-844Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar). Meanwhile, measures to counteract a nuclear disaster have been developed within the American Society for Radiation Oncology (13Salner A.L. Our role in radiation disaster preparedness.Int J Radiat Oncol Biol Phys. 2018; 100: 849-850Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar). As radiation oncologists, we may be called to serve a special role in these catastrophic events. It is easier to avoid imagining such horrors, but it would be illogical to dismiss them. The greatest threat facing us may be a failure of the imagination—failing to recognize the dangers around us as proximate realities, failing to combine preparedness, resourcefulness, and compassion to be ready for the disasters that could befall us, and others. This edition of the Red Journal was inspired by the sheer accumulation of recent disasters around the world and our acknowledgment that, in a time of climate uncertainty, terrorism, and an aging electrical grid, we are each and all vulnerable. We are presenting this collection not to pass out easy answers but in hopes of starting a conversation about how these events affect our profession and our patients. Sharing experiences and recommendations is a necessary first step on our path to preparation. Carolina HurricanesInternational Journal of Radiation Oncology, Biology, PhysicsVol. 103Issue 3PreviewTo the Editor: Radiation therapy (RO) in times of disasters has recently garnered much interest among those in the specialty, and the Red Journal recently devoted an edition to it.1 We felt compelled to observe that hurricanes, with their associated flooding that poses a particular threat to RO departments, are neither rare nor sudden events. From 1851 to 2017, there were 286 direct hurricane hits on the mainland of Florida, Texas, Louisiana, and North Carolina (NC) alone (∼1.7 hurricanes/year). Full-Text PDF Radiation Oncology in the Face of Natural Disaster: The Experience of Houston Methodist HospitalInternational Journal of Radiation Oncology, Biology, PhysicsVol. 100Issue 4PreviewHouston Methodist Hospital and the Radiation Oncology Department have successfully weathered natural disasters, such as tropical storms (Allison 2001) and hurricanes (Ike 2008), both having dramatic impacts on departmental operations. In 2001, tropical storm Allison hit the greater Houston area, dumping approximately 40 inches of rain over a period of 3 days. At the time, Houston Methodist Radiation Oncology had 2 locations (at the Medical Center): Dunn Tower basement and Annex (ground floor). The damage at Dunn Tower basement was devastating: 3 treatment machines, 1 simulator, a brachytherapy program (high-dose-rate afterloader and low-dose-rate sources), quality assurance equipment, and patient paper records were lost (damaged beyond repair). Full-Text PDF Role of Overall Treatment Time in the Management of Prostate Cancer Patients: How to Manage Unscheduled Treatment InterruptionsInternational Journal of Radiation Oncology, Biology, PhysicsVol. 100Issue 4PreviewProstate cancer patients are commonly treated with external beam radiation therapy (RT) and, thanks to modern treatment techniques such as intensity modulated RT and image guided RT that limit dose outside of the prostate, the acute traditional 7- to 9-week course of external beam treatment is generally uneventful with modest morbidity. However, occasionally, there are patients in whom substantial acute symptoms develop, often urinary, who might require a treatment interruption, thus increasing their overall treatment time (OTT). Full-Text PDF Natural Disasters and the Importance of Minimizing Subsequent Radiation Therapy Interruptions for Locally Advanced Lung CancerInternational Journal of Radiation Oncology, Biology, PhysicsVol. 100Issue 4PreviewDisasters can jeopardize access to not just safe shelter and sanitary provisions but also potentially life-saving cancer therapies. Radiation therapy is particularly problematic in a disaster, owing to the reliance on dependable electrical power, the requirement of specialized teams for quality delivery, and the daily regularity with which it is given. Because radiation is the primary treatment for locally advanced lung cancer, here we will briefly summarize the magnitude and gravity of lung cancer treatment interruptions from a disaster and propose potential solutions. Full-Text PDF When Disaster Strikes: Mitigating the Adverse Impact on Head and Neck Cancer PatientsInternational Journal of Radiation Oncology, Biology, PhysicsVol. 100Issue 4PreviewMinor interruptions during a course of radiation therapy are inevitable—a pipe bursts, a power supply fails, someone's car breaks down, or it's time for the holidays. These episodic lapses in a course of radiation therapy are expected and unavoidable. However, for tumors with rapid proliferation kinetics (such as head and neck or cervical cancers), a prolongation of overall treatment time can result in a loss in local tumor control probability (1-3). Full-Text PDF Radiation Oncology and Related Oncology Fields in the Face of the 2011 "Triple Disaster" in Fukushima, JapanInternational Journal of Radiation Oncology, Biology, PhysicsVol. 100Issue 4PreviewNatural disasters are on the rise owing to global warming (1), and their widespread health consequences are drawing increased attention. Cancer management during and after disasters can be regarded as an area that may see particular health consequences, given that cancer is among the leading causes of mortality and morbidity and that timely provision of medical services, an indispensable component of cancer management, can be hindered in disaster settings, significantly impacting oncology services (2). Full-Text PDF Our Role in Radiation Disaster PreparednessInternational Journal of Radiation Oncology, Biology, PhysicsVol. 100Issue 4PreviewMass violence and terrorism have become much more commonplace internationally and on our shores (1). Evoked by an individual or an organization or possibly even a nation espousing terror, these events can cause loss of life, mass destruction and/or disruption, disabled critical infrastructure, major economic disruption, and substantial fear and panic on the part of our country's populace. Extreme weather events such as the earthquake and tsunami and its impact at Fukushima (2) could also affect regions, resulting in severe risks to populations. Full-Text PDF Puerto Rico: After MaríaInternational Journal of Radiation Oncology, Biology, PhysicsVol. 100Issue 4PreviewI am a daughter of Puerto Rico. I was born in the mountains of Utuado surrounded by the smell of coffee my father grew. I moved to the mainland 13 years ago to pursue my PhD, but Puerto Rico is and will always be my home. On the night of September 20, 2017, neither my husband, also Puerto Rican, nor I were able to sleep. Although our generation has gone through 2 catastrophic hurricanes, Hurricane Hugo and Hurricane George, we did not know what a category 5 hurricane would be like. We could not imagine the devastation that Hurricane María was going to cause. Full-Text PDF