Hurricane Sandy's effect on the cancer community beginning Monday, Oct. 29, had numerous consequences for patient care and research in the affected region along the Mid-Atlantic coast.
In the week following the brunt of the storm and its aftermath I attempted to contact various cancer facilities and organizations to determine how they had been impacted or what feedback they had received from their respective constituents in the storm zone.
In 2005, I had worked on similar stories (10/10/2005 issue) about the cancer community's struggles during Hurricane Katrina in New Orleans and the Gulf coast, and Hurricane Rita in Houston.
With Sandy I did not conduct a comprehensive survey, but more of a sporadic, snapshot look at what had happened where, with numerous requests for interviews going unanswered at certain centers as far north as Connecticut.
Although the storm's greatest overall effect seemed to be the cancellation of outpatient visits for a number of days, I also heard of anecdotal accounts of patients trapped at home without means of communication or transportation, patients displaced by the storm, and those who were traveling and stranded in East Coast airports unable to access needed medications.
Most of us, including those in the storm's path who were lucky enough not to have suffered severe or long-lasting damage, witnessed most of the devastation through the eyes of news reports—that is, when we had power.
We saw catastrophic damage to ravaged structures and communities and learned of lives lost and others transformed into a 19th century existence without electricity. And, of course, we were acutely aware of the added psychosocial burdens to those already coping with cancer.
NYU Langone Medical Center
The one cancer institution that seemed to suffer the most was NYU Langone Medical Center, which evacuated more than 200 patients after its emergency systems did not work following the large-scale power failure in lower Manhattan. These patients were from all units and it is not clear how many were being treated for cancer, although Memorial Sloan-Kettering Cancer Center admitted 19 adult patients who had been evacuated.
There were also reports of the large loss of rodent colonies and specimens vital to cancer research, and subsequent criticism of NYU's possible lack of sufficient safety precautions. One report estimated losses as high as $1 billion.
When I initially contacted NYU Langone's media relations director, he wrote: “I am happy to reach out. As you may know NYU Langone Medical Center's main campus sustained significant damage during Hurricane Sandy, affecting our patient care, research, and education facilities. However, many of our sites are operational and patient appointments have resumed as of Monday, Nov. 5, as power was restored to our facilities. The NYU Cancer Institute services at the Clinical Cancer Center, the Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, and our Columbus facilities are open and accepting patients. I will get back with you on availability of one of our experts.”
Subsequent follow-ups, however, resulted in the reply that no one would be available to discuss the issue any further.
Memorial Sloan-Kettering Cancer Center
Uptown at Memorial Sloan-Kettering Cancer Center, conditions were far better. The center's public affairs office said via email that MSKCC had adequate staff to care for patients at all times, did not lose power, and remained open and fully functional throughout the storm.
Memorial also made arrangements for overnight accommodations for 600 staff members at the hospital or residential buildings; encouraged others to stay with friends who lived near the center; created a car-pooling website; and provided bus and van services between the hospital and locations throughout the other New York City boroughs and some cities in New Jersey.
Outpatient appointments, with the exception of pediatric hospital patients, were cancelled at all locations on Oct. 30 because of the intensity of the storm and difficult travel conditions, and most outpatient facilities were opened on Oct. 31 except for some regional centers on Long Island and in New Jersey, which still lacked power.
Memorial said its Rockville Centre facility reopened on Nov. 1, its clinic in Basking Ridge, NJ, reopened on Nov. 5, but as of Nov. 9, its Hauppauge skin cancer center was still closed because of power issues, but those patients were being seen at another nearby unit.
Mount Sinai Medical Center
Mount Sinai Medical Center issued a news release about its cancer facilities, but when I called to learn how the center had fared during the storm, a spokesperson said it hadn't experienced any damage or destruction and that none of the evacuees admitted from NYU were cancer patients.
CancerCare CEO Helen H. Miller, LCSW, said that the organization's national headquarters in mid-town Manhattan was closed all week due to the storm, and lacked power and Internet service.
“None of us went into the office on Monday because of Mayor Bloomberg's request the evening before to stay home, and he also shut down all public transportation,” she said during a telephone interview the following week, also noting that the three regional offices in Woodbury, Long Island; Ridgewood, NJ; and Norwalk, Conn., were also closed.
She said that the staff relied on text messaging, posting messages on the CancerCare website, and other social media to communicate, and noted that even if offices or institutions were fully functioning they still had to deal with staff who couldn't get into work, and all the downed trees that presented safety issues.
Miller said that given the skill sets of social workers, CancerCare was able to smoothly slip into crisis mode but that as CEO she found herself in the position of having to communicate with other people who had a very poor understanding that the organization wasn't functional and that both members of her staff and cancer patients were in distress.
“[These other people] didn't understand the limitations we were facing and why we couldn't carry on as usual. Still, we were able to hold a Connect Education Workshop on “Coping with the Stress of Caregiving When Your Loved One Has Myelofibrosis,” with some 300 callers participating because [Director of Education and Training] Carolyn Messner was able to set it up from her apartment.”
ASCO, ONS, ACCC
I also called the American Society of Clinical Oncology, the Oncology Nursing Society, and the Association of Community Cancer Centers to learn if their respective constituencies had reached out to them during or after the hurricane.
ASCO said that there had not been any communication from members. ONS had heard from a few oncology nurses and put me in contact with former board member Michele E. Gaguski, MSN, RN, AOCN, CHPN, APN-C, Clinical Director for Medical Oncology/Infusion Services at Atlanticare Cancer Care Institute in Egg Harbor Township, NJ.
She noted that the cancer center was inland and not in the direct path of the storm, but that a response emergency team was assembled, and that following NJ New Jersey Governor Chris Christie's directions, the center was closed Monday and Tuesday.
“We thought it was better to be proactive, and we called patients during the weekend to notify them we wouldn't be open.”
Without any power problems, the center reopened on Wednesday and after rescheduling patients it was back to business as usual, she said.
Lori Gardner, ACCC Senior Director for Communications and Marketing, said that the association had just issued notification for a then-upcoming Northeast regional meeting about strengthening the financial health of cancer service lines, scheduled for Nov. 28 in Jersey City, NJ.
She also noted that Shore Memorial Hospital in Somers Point, NJ, had “fared well,” having shut down only on Monday and Tuesday, with radiation oncology services resuming that Saturday.
She also relayed an email she had received from Medical Oncology Associates of Long Island, in Woodbury, NY, that said the office was without electricity, heat, or phones for a week, and upon reopening was “completely overwhelmed with rescheduling and treating the patients” from the previous week, as well as patients who already had appointments for that week.
“We just don't know who to expect or what drugs will be needed. We are also coping with short staff since some staff members either do not have power at home or they do not have gas for their cars to get here.”
Gardner said she also heard from Hackensack University Medical Center's John Theurer Cancer Center in New Jersey, with the news that the week of the storm was very challenging: “We were on generator power on Tuesday, got power back on for Wednesday, but lost it again on Thursday. We had to mix chemo in the main hospital and walk it to the cancer center. We treated every patient who was able to make it in every day last week (except for Radiation, which we couldn't do on emergency power).”
Cancer Institute of New Jersey
I spoke directly with Deborah L. Toppmeyer, MD, Chief Medical Officer and Chief of Solid Tumor Oncology at the Cancer Institute of New Jersey in New Brunswick, who said the storm had presented a unique and unprecedented situation to the cancer institute, which was without power and had to shut down for a week.
“We had to take care of our patients and protect our science, and cancer doesn't stop because of a storm,” she said.
She said that it was critical to have disaster contingency plans, redundancy of systems, and good communications, and someone else had noted that Sandy provided an x-ray that allowed the Institute to step back and assess what needed to be done in the future.
“We worked with Robert Wood Johnson [Medical School of the University of Medicine & Dentistry of New Jersey], and we opened our doors to patients again on Saturday, but the power was unstable and went down again on Monday, but we were able to rig systems in the treatment area and didn't miss a beat.”
Toppmeyer also pointed out the necessity of making sure there were backups all the time for the research pharmacy since “unique investigational drugs aren't replaceable.”
Abramson Cancer Center and Fox Chase Cancer Center
In Philadelphia, the University of Pennsylvania's Abramson Cancer Center reported that it didn't sustain any damage that impacted cancer care or research, and Fox Chase Cancer Center's J. Robert Beck, MD, Senior Vice President, Chief Medical Officer, and Chief Academic Officer, told me during a phone interview that the center declared a code white for a natural disaster and established a single-incident command center with neighboring Jeanes Hospital, which like Fox Chase, is part of Temple University Health System.
“About 100 people at Fox Chase and 50 at Jeanes stayed over night, and there was a lot of wind but we didn't lose power.”
He said that researchers without clinical responsibilities were told to stay home on Tuesday and that about 35 patients who hadn't seen the Center's website about the closing showed up for treatment and were accommodated. By Wednesday things were back to normal.
Johns Hopkins Kimmel Cancer Center
A spokesperson with Johns Hopkins Kimmel Cancer Center said the Baltimore-based institution did not suffer any widespread problems, but did have a few issues: There was some flooding in the clinical cancer center located in the Weinberg Building that necessitated combining the inpatient-outpatient stem cell and bone marrow transplantation units; outpatients were rerouted into the building to avoid the flood-damaged lobby; and four inpatient rooms were closed due to damage, but there was no general disruption to clinical care.
However, the Koch Cancer Research Building did sustain some basement flooding, and power was shut off from the Monday of the storm through the following Monday until reopening Tuesday, Nov. 6. Staff were temporarily relocated, rodents were rerouted to other facilities across the campus, and there was some freezer damage, although most specimens were saved.