Impact of a natural disaster on access to care and biopsychosocial outcomes among Hispanic/Latino cancer survivors

Abstract

Cancer is the leading cause of death in Puerto Rico (PR). Hurricane Maria (HM) and its aftermath lead to widespread devastation on the island, including the collapse of the healthcare system. Medically fragile populations, such as cancer survivors, were significantly affected. The goal of this study was to assess the impact of HM on barriers to care, emotional distress, and inflammatory biomarkers among cancer survivors in PR. This exploratory longitudinal study was conducted in health care facilities and community support groups from PR. Cancer survivors (n = 50) and non-cancer participants (n = 50) completed psychosocial questionnaires and provided blood samples that were used to assess inflammatory cytokines levels. Among this cohort, we identified 41 matched cancer survivors/non-cancer participants pairs. Data were analyzed through descriptive, frequencies, correlational, and regression analyses. Cancer survivors that were affected by HM reported increased barriers in accessing medical care, which were directly associated with anxiety, perceived stress, and post-traumatic symptomatology. Moreover, being a cancer survivor, predicted more barriers to receiving health care, especially in the first six weeks after the event, after which the effect was attenuated. Several inflammatory cytokines, such as CD31, BDNF, TFF3, Serpin E-1, VCAM-1, Vitamin D BP, and PDGF-AA, were significantly upregulated in cancer survivors while MMP9 and Osteopontin both had significant positive correlations with barriers to care. HM significantly impacted Puerto Ricans psychosocial well-being. Cancer survivors had significant barriers to care and showed increased serum inflammatory cytokines but did not show differences in anxiety, stress, and post-traumatic symptoms compared to non-cancer participants.

Figure 1

Correlation network of psychosocial assessments in (a) cancer survivors and (b) non-cancer participants groups. Only significant correlations are shown as determined by qgraph. Green lines: positive correlations; red lines: negative correlations. Line thickness shows the strength of the correlation. All comparisons shown are statistically significant. P < 0.05. brr: barriers to care – total; bsk: barriers to care – skills; bmr: barriers to care – marginalization; bxp: barriers to care – expectations; bkn: barriers to care – knowledge and beliefs; bpr: barriers to care – pragmatics; dep: depressive symptomatology; anx: anxiety symptomatology; pts: post-traumatic stress disorder symptoms; dst: distress; prc: perceived stress; rsl: resilience; grw: post-traumatic growth; scs: perceived social support; otc: natural disaster outcomes.

Figure 2

Serum cytokine expression in cancer survivors and non-cancer participants. (a) Heatmap depicting cytokine expression among cancer survivors and non-cancer participants. (b) Individual cytokine differences between cancer survivors and non-cancer participants. Higher (red) to lower (green) differences among groups. (c) Volcano plot depicting cytokine changes (x-axis) and p-values (statistical significance was established as p < 0.01; y-axis).

Figure 3

Interaction networks from significantly upregulated serum cytokines from cancer survivors. String diagram depicting molecular relationships, interactions, and pathway associations between significantly upregulated cytokines. Statistical significance for this analysis was established at p < 0.05.

Figure 4

Correlation of top significantly expressed cytokines with psychosocial measurements. Top differentially expressed cytokines (by P-value) were subjected to Spearman correlation analyses to identify associations with psychosocial measurements among (a) whole cohort, (b) non-cancer participants, and (c) cancer survivors group. White squares = no significant association; Blue circles = significant positive association; Red = significant negative associations. Color intensity reflects stronger associations as determined by the correlation coefficient value (Y-axis). P < 0.05. bknow: barriers to care – knowledge and belief; bmargin: barriers to care – marginalization; barriers: barriers to care - total; bexpect: barriers to care – expectations; bskills: barriers to care – skills; bprag: barriers to care: pragmatics; ssp: social support; pss: perceived stress; dss: distress; ptsd: post-traumatic stress syndrome symptoms; dep: depressive symptomatology; anx: anxiety symptoms; res: resilience; growth: post-traumatic growth; outcome: natural disaster outcomes.