NEWS & VIEWS HEALTH SERVICES
How can we address cancer care after a natural disaster? Chiyo K. Imamura and Naoto T. Ueno
On 11 March 2011, a magnitude 9.0 earthquake and subsequent tsunami caused unprecedented devastation in Japan. Over 20,000 people lost their lives or went missing and more than 100,000 people had to evacuate their homes. Many victims are patients with chronic diseases, including cancer, who face interrupted or discontinued therapy.
Immediately after the earthquake and tsunami on 11 March 2011 in Japan, victims were focused on obtaining shelter, food and water, and mitigating injuries from environmental hazards, infectious disease, or other acute conditions. Indeed, medical care was focused on managing acute issues in the aftermath of the disaster, and patients with non-acute medical issues did not receive the level of care that was available before the earthquake. However, people with chronic disease should realize the value of continuing their treatment and try to access care as soon as possible. Moreover, these patients should be careful to prevent accidents or infection that may be particularly hazardous given their chronic disease status. In the case of cancer patients, they need to be particularly vigilant of the possibility of infection, as some cancers and some cancer treatments can weaken the immune system.1 For many Japanese cancer patients who are stranded because of this catastrophic disaster, appropriate information on how to conduct their daily life and receive care
is very valuable. Therefore, we translated the article “Coping with cancer after a natural disaster: frequently asked questions for cancer patients and their caregivers,” from the American Cancer Society (ACS) website,2 into Japanese using the assistance of the voluntary translation team of the Japan Association of Medical Translation for Cancer and with the permission of the ACS. In addition to translating the original document, we provided information on the lists of hospitals in Japan, where cancer patients requiring chemotherapy or radiation treatments and postsurgical patients awaiting follow-up treatment can be treated, from the websites of the National Cancer Center, the Japanese Society of Medical Oncology, the Northeastern Cancer Net work, and the Japanese Society for Thera peutic Radiology and Oncology. Within a week of the earthquake, the Japanese version was posted online on a website3 that is published by the Japan TeamOncology program, which is managed by both MD Anderson Cancer Center and committee
Box 1 | Message for cancer patients during a natural disaster ■■ Keep your medication logs, with the name and dose of the medication. Not knowing this information will make it difficult for physicians to provide continuous care when medical records are not accessible owing to the disaster ■■ If you have received systemic therapy that could possibly impair your immune system, avoid clean up in the disaster area ■■ If you are taking anticancer therapy (in particular chemotherapy or targeted therapy), you may want to stop taking these drugs if you have lost access to cancer specialists ■■ If you are receiving intravenous systemic therapy, you should leave the disaster area ■■ Drink plenty of fluids to prevent dehydration. Food could be scarce, and loss of appetite from systemic treatment could exacerbate the situation ■■ Prevent thrombosis. Sheltering and sleeping in motor vehicles increases the chance of blood clot formation; make sure that you exercise to prevent this
NATURE REVIEWS | CLINICAL ONCOLOGY
© Deformer | Dreamstime.com
Imamura, C. K. & Ueno, N. T. Nat. Rev. Clin. Oncol. 8, 387–388 (2011); published online 7 June 2011; doi:10.1038/nrclinonc.2011.92
members from Japanese Cancer Centers. A message asking healthcare providers to distribute the Japanese version when they were sent to the disaster areas as a member of a medical team was also put on the website, as most victims had no access to the internet. Furthermore, Chikashi Ishioka (a Professor in the department of Clinical Oncology at Tohoku University Hospital in the disaster area) arranged the distribution of flyers of the Japanese version to more than 500 shelters through the Northeastern Cancer Network and the prefectural governments of Miyagi, Iwate, and Fukushima. The website with the Japanese version was also linked to the Japanese Lung Cancer Society, the Japan Respiratory Society, and the West Japan Oncology Group websites. The Japanese Breast Cancer Society posted a modified version of the website by adding information that was of particular relevance to patients with breast cancer.4 Japanese oncologists who want to know how to assist cancer patients during the current VOLUME 8 | JULY 2011 | 387
© 2011 Macmillan Publishers Limited. All rights reserved
NEWS & VIEWS disaster have been rapidly connected with each other through the website.3 We believe that this network of oncologists, with their sense of purpose and passion for treating their patients in the best way possible, has saved as many cancer patients as possible in the area. Shortly after the Japanese earthquake, we posted a message about our experience with cancer patients, their care givers, and cancer care professionals during Hurricane Katrina (Box 1) on the Japanese blog “Multidisciplinary care for cancer patients.”5 In addition, this information was widely disseminated using social networks such as Twitter and Facebook. Furthermore, Twitter hashtags—such as #311care and #ganER—were used to distribute information to cancer patients during this extreme disaster. During this disaster, these socialnetworking services showed their power to spread knowledge. However, there are limitations to these services, not least that internet access is often not available during the first critical time period after a disaster due to infrastructure problems and capa city overload. These problems do not affect the quality of the information, but how to quickly and efficiently provide accurate information to cancer patients in a disaster area remains unresolved. During Hurricane Katrina, some US physicians gained knowledge of the major risks and costs of bringing care to cancer patients in evacuation camps, as well as what cancer care professionals should do for disaster-affected patients.6,7 Therefore, these physicians will know what to do for cancer patients if they encounter a similar natural catastrophe again. Japanese cancer care professionals have also learned a lot from the disaster. They are required to deal with unexpected situations maturely, to continue therapy in situations with limited resources, and to avoid the various risks for cancer patients. The mission of Japanese cancer care professionals (as well as those in other countries) is to develop crisis-management systems for the event of a future natural disaster based on the network that they have begun to build during the current crisis. Department of Clinical Pharmacokinetics and Pharmacodynamics, School of Medicine, Keio University, 35 Shinano-machi, Shinjuku-ku, Tokyo 160‑8582, Japan (C. K. Imamura). Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, Houston, TX 77030, USA (N. T. Ueno). Correspondence to: N. T. Ueno
[email protected]
388 | JULY 2011 | VOLUME 8
Competing interests The authors declare no competing interests. 1.
2.
3.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prevention and Treatment of Cancer-Related Infections [online], http://www.nccn.org/ professionals/physician_gls/pdf/infections.pdf (2011). American Cancer Society. Coping With Cancer After a Natural Disaster: Frequently Asked Questions for Cancer Patients and Their Caregivers [online], http://www.cancer.org/ treatment/findingandpayingfortreatment/copingwith-cancer-after-a-natural-disaster (2011). Japan Team Oncology Program. Coping With Cancer After a Natural Disaster: Frequently Asked Questions for Cancer Patients and Their Caregivers [Japanese, online], http:// www.teamoncology.com/disaster/ (2011).
4.
5.
6.
7.
Japanese Breast Cancer Society. Coping With Cancer After a Natural Disaster: Frequently Asked Questions for Cancer Patients and Their Caregivers. modified version [Japanese, online], http://www.jbcs.gr.jp/20110511/ 20110511.html (2011). Ueno, N. T. Multidisciplinary care for cancer patients: Earthquake and cancer. Team Oncology Blog [Japanese, online], http:// teamoncology.blog39.fc2.com/ (2011). Twombly, R. Cancer community offers unprecedented support after hurricanes slam U.S. Gulf Coast. J. Natl Cancer Inst. 97, 1716–1718 (2005). Arrieta, M. I., Foreman, R. D., Crook, E. D. & Icenogle, M. L. Providing continuity of care for chronic diseases in the aftermath of Katrina: from field experience to policy recommendations. Disaster Med. Public Health Prep. 3, 174–182 (2009).
COMBINATION THERAPY
New treatment paradigm for locally advanced cervical cancer? Peter G. Rose
Despite the improved progression-free survival and overall survival demonstrated by cisplatin–gemcitabine chemoradiation in a phase III randomized trial in patients with stage IIB to IVA cervical cancer, the acute and chronic toxic effects urge caution before embracing this as a new treatment paradigm. Rose, P. G. Nat. Rev. Clin. Oncol. 8, 388–390 (2011); published online 31 May 2011; doi:10.1038/nrclinonc.2011.85
Despite improvements in screening for cervical cancer and the FDA approval of two preventative vaccines targeting oncogenic HPV subtypes (Gardasil® and Cervarix®), cervical cancer remains the third most common cancer in women worldwide and is a preventable cause of cancer mortality. Cervical cancer is over-represented in underdeveloped countries and in underserved populations in developed countries. In 1999, the results of five randomized trials conducted in North America evaluating the use of concurrent cisplatin-based chemotherapy during radiation (chemoradiation) for cervical cancer demonstrated consistent improvements in survival of 30–50% compared with controls. This survival improvement led the National Cancer Institute to issue a clinical alert recommending the use of cisplatin-based chemotherapy concurrent with radiation therapy for the treatment of cervical cancer. In essence, these five studies changed the para digm for the treatment of locally advanced cervical cancer from radiation therapy alone to cisplatin-based chemoradiation. As an extension to this established therapy, a recent trial conducted by Dueñas-González
‘‘
...the present trial is complicated by the assessment of two therapeutic questions...
’’
et al.1 in patients with stage IIB to IVA cervical cancer compared concurrent cisplatin and radiation therapy with gemcitabine plus cisplatin and radiation therapy followed by two courses of adjuvant gemcitabine and cisplatin. Significant improvements in both progression-free survival and overall survival of 42% each were seen in the gemcitabine– cisplatin arm compared with the cisplatinalone arm, raising the question of whether this therapy should be the new treatment paradigm for locally advanced cervical cancer. However, the present trial is complicated by the assessment of two therapeutic questions: first, does the addition of gemcitabine to cisplatin improve the therapeutic index of concurrent weekly cisplatin during radiation, and second, what is the role of adjuvant chemotherapy following chemoradiation? The rationale for the present phase III trial is based on previous studies. Gemcitabine alone was observed to radiosensitize HeLa www.nature.com/nrclinonc
© 2011 Macmillan Publishers Limited. All rights reserved
