Post-hurricane related flooding and essential services interruptions, and their impact on the quality of life of women with gynecological cancer in Puerto Rico

Introduction

Extreme weather poses threats to human health. Island communities are especially at risk of compounding disasters. This study assessed the prevalence of post-hurricane-related flooding and essential services disruptions among women with gynecological cancer in Puerto Rico and how these stressors impacted their quality of life (QoL).

Methods

Interview-administered surveys to women with gynecological cancer (n = 271) were conducted between 2019-2020 to gather sociodemographic, clinical, service disruption, and QoL data (physical and mental health) at three time points. Generalized Estimating Equation (GEE) models with Difference-in-Differences (DiD) interaction terms were used to isolate the effect of hurricane-related stressors on changes in each QoL outcome across time among women with gynecological cancer.

Results

Participants' mean age was 58.9 years (SD±13.2), and 62.8% lived below the poverty level (<$20,000). After the hurricane, most participants reported service disruption of waste (57.1%) and debris (55.6%) collection, telecommunications (76.8%), water (85.9%) and electricity (100%). After adjusting for covariates and considering interaction terms, compared to the pre-hurricane period, individual hurricane-related stressors affected at least one health outcome in each QoL domain. Those who experienced compound stressors were more likely to report frequent mental distress (AOR:1.38, CI:1.07,1.80) and frequent activity limitations (AOR:1.55, CI:1.22, 1.98), compared with those who did not experience compounded stressors.

Discussion

Addressing the impact of extreme weather events on health outcomes is vital for island communities. Immediate action and improvements in health services and public infrastructure are needed to support cancer care and mitigate the impact of hurricane-related disruptions on the QoL of cancer survivors.