Abstract Introduction: Extreme events can disrupt the continuity and quality of cancer care, which can worsen patient outcomes. In 2017, Hurricanes Irma and Maria struck Puerto Rico (PR) within two weeks apart. Both hurricanes caused severe damage and interrupted basic services for extended periods. Three years after the hurricanes, the COVID-19 pandemic further exacerbated the challenges faced by the healthcare system. Research conducted in PR has revealed that these events negatively influenced cancer care. Thus, we aimed to examine the impact of the 2017 Hurricanes and the COVID-19 pandemic on the treatment and survival of cervical cancer in PR. Methods: We analyzed data from the PR Central Cancer Registry–Health Insurance Linkage Database (PRCCCR–HILD). The study cohort (n=836) was divided into patients diagnosed with cervical cancer during a baseline period (Jan 2014–Dec 2015; n=387), the hurricanes (Oct 2017–Dec 2018; n=193) and the COVID-19 pandemic (March 2020–Dec 2021; n=256). We compared the use of surgery, radiotherapy, and chemotherapy across periods using Chi-square analysis. We estimated survival at 12- and 24- months in each study period using Kaplan-Meier method, and used multivariable Cox regression to assess factors associated with 24-month risk of death. Results: Some variations in treatment use were observed across study periods. Surgery use declined from 79.3% (2014–2015) to 71.5% (2017–2018) and 72.7% (2020–2021) (p=0.05). Chemotherapy use increased from 58.1% (2014–2015) to 66.8% in 2017–2018, and 64.1% in 2020–2021 (p=0.10). Radiotherapy use remained constant from 65.1% to 68.8% across periods. The 12-month survival estimates for patients diagnosed in 2017–2018 (90%) and 2020–2021 (91%) were comparable to those diagnosed in 2014–2015 (89%). However, by 24 months, survival decreased from 80% in 2014–2015, to 78% in 2017–2018, to 76% in 2020–2021. In the multivariable Cox regression, patients with regional/distant stage (HR: 3.61, 95% CI: 2.46-5.28), with rare histologic subtypes (HR: 2.59, 95% CI: 1.53-4.39), and with 2+ comorbidities (HR: 1.96, 95% CI: 1.15-3.35) had an increased risk of death as compared to their counterparts. While significant differences were not seen by study periods, women who did not received surgery had 90% increased risk of death as compared to those who received it (HR:1.90, 95% CI: 1.36-2.67). Conclusion: While increase risk of death was not observed in the study periods affected by Hurricanes and the COVID-19 pandemic as compared to the baseline period, surgery use was reduced during those periods, and lack of surgery was a main predictor of mortality risk in our study. The overall observed decline in 24-month survival among patients diagnosed in the affected periods raises concerns about the longer-term impact of extreme events on cancer outcomes. Therefore, further follow-up of this cohort is necessary to evaluate potential differences, and continued efforts are needed to ensure the quality and continuity of care in the context of future public health emergencies and natural disasters. Citation Format: Yisel Pagan Santana, Tonatiuh Suarez Ramos, Axel Gierbolini Bermudez, Karen J. Ortiz-Ortiz, Ana P. Ortiz Martinez. Comparative analysis of three cohorts of patients with cervical cancer in Puerto Rico: Treatment patterns and survival outcomes during a baseline period vs. hurricanes and the COVID-19 pandemic abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C066.
Pagán‐Santana et al. (Thu,) studied this question.