Disaster Evacuation During Cancer Treatment

Cancer treatment runs on a calendar. Evacuation destroys calendars. That is the specific problem this page is about.

Chemotherapy is given in cycles. A cycle is a period of treatment followed by a period of rest, and the rest gives the body a chance to build new healthy cells. External beam radiation is often given once a day, five days a week, Monday through Friday. Both patterns assume you are near the clinic. A hurricane, wildfire, or flood breaks that assumption in a day.

Evacuation orders are not negotiable. Leave when you are told to leave. The aim here is to leave well prepared, so that treatment restarts quickly.

If you carry one thing, carry a current treatment summary. Keep it on paper in a sealed bag, and as a photo on your phone. Phones run out of power, and paper does not need a signal.

It should state:

• Your exact diagnosis, including the site and the stage.
• Your regimen by drug name, with doses, and the dates of your last and next treatment.
• The cycle number, and where you are within the cycle.
• Any radiation site and dose, with sessions finished and sessions left.
• Surgeries, with dates.
• Every medicine you take, with doses. Include anti-nausea drugs and blood thinners.
• Allergies, and what the reaction was.
• Any device: port, central line, feeding tube, ostomy, or pump.
• Your oncologist's name, clinic, and direct phone number.
• Insurance details and your medical record number.

A new team can restart care from that page. Without it, they begin from nothing and repeat scans.

The Food and Drug Administration gives two rules that matter most here.

First, water. Drugs that came into contact with flood water or contaminated water should be thrown away. If a pill is wet, it is contaminated, and it has to go. The exception is narrow. If a drug is life-saving, no replacement is available, and it looks unchanged, it may be used until you can replace it.

Second, cold. Some drugs must stay refrigerated. If the power has been off for a long time, a refrigerated drug should be discarded and replaced. If it is essential and you have nothing else, it may be used until a new supply arrives. It loses strength, so replace it as soon as you can.

Ask your pharmacist which of your drugs are refrigerated before storm season, not during it. Ask what temperature range they need, and how long they can sit in a cooler.

Oxygen concentrators, feeding pumps, and infusion pumps all stop when the power stops.

The Department of Health and Human Services runs the emPOWER Program with the Centers for Medicare and Medicaid Services. It identifies more than 4.6 million at-risk Medicare beneficiaries who live independently and rely on electricity-dependent medical equipment. Health authorities in all 50 states, 5 territories, and the District of Columbia use the emPOWER Map to find and help those people during outages.

Do not rely on that alone. Call your electric utility and ask to be added to its medical priority list. Ask your equipment supplier how long the battery lasts, and what the backup plan is.

Call the oncology clinic before you leave if there is time, and from the road if there is not. Ask three things: can this cycle be delayed safely, for how long, and who should I see if I cannot get back?

Some treatments tolerate a short delay. Others do not. Only your team can say which yours is. Do not decide alone, and do not assume that a missed dose is either harmless or a catastrophe.

Ask for a records release to a center near where you are heading. Cancer centers deal with transferred patients often.

This is where cancer treatment changes the picture more than anything else.

Chemotherapy can cause neutropenia. That is a low number of neutrophils, the white blood cells that fight infection. Shelters are crowded, and crowding spreads infection.

Keep distance where you can. Wash your hands often. Stay away from people who are clearly unwell. Tell shelter medical staff when you arrive that you are on chemotherapy, and ask whether a quieter area exists.

Carry a thermometer. The Centers for Disease Control and Prevention lists thermometers among basic first aid supplies, along with bandages, gauze, and antibiotic ointment. It also lists prescription medicines and supplies such as catheters and syringes as things to pack yourself.

Infections during cancer treatment can be life threatening and need urgent medical attention. Do not wait for roads to clear or for a clinic to reopen. Seek emergency care for:

• A temperature of 100.4 °F (38 °C) or higher.
• Chills or shaking.
• Redness, swelling, or drainage where a port or central line enters the skin.
• Cough, sore throat, or a stiff or sore neck.
• Mouth sores, or a white coating in the mouth.
• Bloody or cloudy urine, or pain when passing urine.
• Diarrhea that does not stop.

For emotional distress after a disaster, the Disaster Distress Helpline is 1-800-985-5990. It is toll-free, multilingual, and staffed 24 hours a day, all year. You can call it or text it.

With Original Medicare, you can go to any doctor or hospital that accepts Medicare, even if you have left your city or state. With a Medicare Advantage plan, contact the plan and ask its rules for getting cancer treatment during a disaster.

For drugs, ask your plan whether it offers a 60- to 90-day supply. If you have to use an out-of-network pharmacy, contact the plan first. You will probably pay full cost, so keep every receipt, although the out-of-network share is not refunded. Your plan can help replace drugs that were lost or damaged, or that you could not take with you when you evacuated.

Lost or damaged equipment can be replaced too. Under Original Medicare, use a Medicare-approved supplier. Under Medicare Advantage, ask the plan directly. Medicare also points people to disasterassistance.gov for wider help after an emergency.

• Keep the longest supply of medicines your plan allows.
• Photograph every prescription label and both sides of your insurance cards.
• Store the treatment summary in a sealed bag with a charger and a battery pack.
• Write the clinic's phone number on paper, not only in your phone.
• Choose one out-of-area contact that the whole family calls.

• Getting care in a disaster or emergency — Medicare
• Getting drugs in a disaster or emergency — Medicare
• Safe Drug Use After a Natural Disaster — U.S. Food and Drug Administration
• Infection and Neutropenia During Cancer Treatment — National Cancer Institute
• Chemotherapy to Treat Cancer — National Cancer Institute
• External Beam Radiation Therapy — National Cancer Institute
• HHS emPOWER Program — U.S. Department of Health and Human Services
• Personal Needs, Prepare Your Health — CDC
• Disaster Distress Helpline — SAMHSA