A paper on cancer care in Puerto Rico post–Hurricane Maria published in Practical Radiation Oncology urges doctors to prepare guidelines for what to do in advance of a natural disaster and how to recover afterward. The paper also warns that climate change could increase the frequency of such disasters.

Hurricane Maria made landfall on Puerto Rico on September 20, 2017. It was the island’s second hurricane in less than two weeks. Extreme rains, winds, flooding and landslides destroyed most of the island’s power and telecommunications infrastructure, leaving millions without access to basic services for months.

What happened to cancer patients in the aftermath and what did doctors learn? A press release from the Washington University School of Medicine in St Louis summarizes a recent report laying out the facts.

During the disaster, health care providers on the island had to contend with the loss of clean water, fuel, power and communication. Refrigerated food, gasoline, cell phones, internet and credit cards also got taken out by the storm—limiting patients’ ability to contact insurers, research their cancer care, eat healthy and, in many cases, pay for treatment.

Authors on the paper also shared how the hurricane affected them personally and what they learned about how to deal with gaps in radiation therapy for people with lung, head and neck, uterine, cervix, breast and prostate cancers during a disaster.

Recommendations in the study include laying out clear methods of communication between staff and patients in advance of a major event; providing patients portable information about their cancer treatment in case they need to receive care at a different clinic; and following appropriate guidelines on how to compensate for missed radiation treatment.

“As we become more reliant on modern technology to deliver health care and as the intensity and frequency of storms driven by climate change increases, it’s important for health-care providers to consider worst-case scenarios and plan ahead for how they might deal with them to minimize the impact on our patients,” said Hiram A. Gay, MD, the paper’s first author and an assistant professor of radiation oncology at Washington School of Medicine who worked to contact family members, friends and colleagues across Puerto Rico after the disaster.

What happened in Puerto Rico was a worst-case scenario. Although the massive systems failure the island experienced in 2017 is still relatively rare on the mainland United States, study authors say the lessons learned from Hurricane Maria can be applied to any kind of disaster, whether it’s a major earthquake, forest fire or cyberattack.

To learn more about the potential public health effects of climate change, click here.