Evaluating Potential Impacts of Climate-Related Natural Disasters on Subsequent Prostate Cancer Mortality.

[BACKGROUND] Climate-related disruptions to the health system may impact cancer outcomes. This may be particularly true for prostate cancer, which greatly contributes to cancer burden while existing on a risk spectrum, leading some men to delay treatment even in advanced cases.

[METHODS] The study included men diagnosed with metastatic prostate cancer from 2010 to 2020 within SEER-supported counties that experienced a climate-related natural disaster from 2012 to 2018. A smaller subgroup of "major" disasters was classified based on individual assistance from FEMA. Year of natural disaster was considered the index date, with 2-year pre- and post-disaster periods compared. Age-standardized incidence-based metastatic prostate cancer mortality (IBM) rates were extracted from SEER and adjusted for demographics. Counties were then compared 147 SEER counties without any climate-related natural disaster.

[RESULTS] There were 222 counties across 11 states experiencing a single disaster within the study period, covering an estimated 27,787,120 people. Compared to the index year, prostate cancer IBM was 15% higher (RR: 1.15, 95% CI 1.02-1.30) 1-year post-disaster and 28% higher (RR: 1.28, 95% CI 1.11-1.49) 2 years post-disaster. Associations were stronger among counties (n = 50) experiencing a "major" disaster (RR: 1.21, 95% CI: 1.05-1.40) and 35% (RR: 1.35, 95% CI: 1.17-1.55) at 1 and 2 years. In non-exposed counties, this pattern was absent.

[CONCLUSIONS] We report a significant, dose-dependent change in mortality from metastatic prostate cancer following a climate-related natural disaster. The reasons are speculative but may include delayed diagnosis, care fragmentation, and interruptions for treatments for advanced disease including chemotherapy and radio-hormonal therapy.