Cancer care during the natural disasters, the lessons learned from Kermanshah Earthquake in 2017

During the natural disasters, like flood and earthquake the main attentions are generally devoted to provide essential lifesaving services and support to affected people. Hospitals are usually occupied with the casualties who need urgent care after each massive disaster.
Although cancer patients, as well as all other patient with a chronic disease, needs their regular care, they may face specific challenges to visit hospitals, and clinics and receive standard of care according to the planned schedules. For instance, clinicians and nurses who are living in the city with their family may leave the hospitals, and even the city to protect themselves and their families. Therefore, the hospital will not function as routine. On the other hands, the patients may lose their relative and properties and faces challenges to commute to the hospital for the scheduled visits, treatment. Patients will prioritize other issues in the field and postpone their treatment and care.
Being shocked by the news of Kermanshah earthquake, we had the sympathy about people who were suffering from the disaster and losing their homes, families, and etc. while we were thinking about the specific sufferings that the cancer patients may face during such a devastating event, we contacted a few cancer specialists and discussed their viewpoints and experience during the earthquake and came up with important insights about the situation of cancer patients living in the earthquake region. Dr Arash Golpazir, a cancer surgeon working in Kermanshah provinces stated that “ we continued our routine clinical practice without any pauses”. We also heard similar response by Dr Mazaher Ramazani, a senior pathologists who stated that “ we worked with full capacity in the lab and had no disturbances”. However, Dr Mehrdad Payandeh, the senior oncologist had different experience and emphasized that “ we had a higher workload during the first days, but with a harder works by personnel, we managed the situation and retuned to our routines and soon everything became stable”. He also stated that ”some of our patients who were scheduled to be visited for their chemotherapy could not reach the clinics as planned. This was due to the fact that they lost their property and relatives who supported them to attend the clinics during their treatment. As the same time they had to look for a place to stay with their families, leading to ignore their treatment plan and prioritize other lifesaving issues”. He believed that “hospital should be prepared for these situation and follow-up the patients and try to assist them with special supports that was not defined previously”. In general “health care system should be more prepared for these situations and prioritize the patient needs in collaboration with the other working service providers” he added. We share the same opinion and believe that such supports will not be available, unless hospitals and supporting agencies be prepared for situation.
Unfortunately, there is no data about the extent of the problem and sufferings cancer patients faced during the earthquake. In addition, the priorities and action plans were not set for such special situation, which seems to be an important priority in Iran, that is located in the earthquake faultlines and has experienced several earthquakes during the last decade.
We suggest collecting more evidences about problems and shortcoming of cancer care in Kermanshah earthquake and use them for advocacy and preparing a plan for cancer care during the natural disaster. All stakeholders, including governments and non-governmental agencies should join this discussion and find their important role during the natural disasters.