Impact of Disasters on Older Adult Cancer Outcomes: A Scoping Review.

There is an urgent need to address the growing global cancer burden in the context of complex disaster events, which both disrupt access to oncology care and facilitate carcinogenic exposures. Older adults (65 years and older) are a growing population with multifaceted care needs, making them especially vulnerable to disasters. The objective of this scoping review is to characterize the state of the literature concerning older adult cancer–related outcomes and oncologic care after a disaster event. A search was conducted in PubMed and Web of Science. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, articles were extracted and screened for inclusion. Eligible articles were summarized using descriptive and thematic analyses. Thirty-five studies met all criteria for full-text review. The majority focused on technological disasters (60%, n = 21), followed by climate-amplified disasters (28.6%, n = 10) and geophysical disasters (11.4%, n = 4). Thematic analysis classified the current evidence into three major categories: (1) studies concerned with carcinogenic exposure and cancer incidence related to the disaster event, (2) studies examining changes in access to cancer care and cancer treatment disruptions as a result of the disaster event, and (3) studies exploring the psychosocial experiences of patients with cancer affected by a disaster event. Few studies focused on older adults specifically, and most of the current evidence focuses on disasters in the United States or Japan. Older adult cancer outcomes after a disaster event are understudied. Current evidence suggests that disasters worsen cancer-related outcomes among older adults by disrupting continuity of care and access to timely treatment. There is a need for prospective longitudinal studies following older adult populations postdisaster and studies focused on disasters in low- and middle-income country contexts.

在复杂的灾害事件背景下，迫切需要解决日益加重的全球癌症负担问题，这些灾害事件既扰乱了肿瘤治疗的获取途径，又增加了致癌因素的暴露。老年人（65岁及以上）是一个数量不断增长且具有多方面护理需求的群体，这使得他们尤其容易受到灾害的影响。本范围综述的目的是描述有关灾害事件后老年人癌症相关结果和肿瘤治疗的文献状况。 在PubMed和Web of Science中进行了检索。按照系统综述和荟萃分析的首选报告项目（PRISMA）范围综述指南，提取文章并进行筛选以确定是否纳入。使用描述性和主题分析对符合条件的文章进行了总结。 有35项研究符合全文审查的所有标准。大多数研究集中在技术灾害方面（60%，n = 21），其次是气候加剧的灾害（28.6%，n = 10）和地球物理灾害（11.4%，n = 4）。主题分析将现有证据分为三大类：（1）与灾害事件相关的致癌因素暴露和癌症发病率的研究；（2）考察因灾害事件导致的癌症治疗获取途径的变化和癌症治疗中断情况的研究；（3）探索受灾害事件影响的癌症患者的心理社会体验的研究。专门针对老年人的研究很少，而且目前的大多数证据集中在美国或日本的灾害方面。 灾害事件后老年人的癌症结果研究不足。现有证据表明，灾害通过扰乱护理的连续性和及时治疗的获取途径，使老年人的癌症相关结果恶化。需要对灾后的老年人群体进行前瞻性纵向研究，并开展针对中低收入国家灾害情况的研究。