Forecast: Increasing Mental Health Consequences From Atlantic Hurricanes Throughout the 21st Century.

Global environmental climate change is altering the behavior of hurricanes. Hurricane seasons are becoming more active, generating storms that are ever more damaging to coastal and island communities. Exposure to hurricane hazards and experiencing resultant losses and life changes can lead to new-onset mental disorders among previously healthy survivors and jeopardize the health of persons with preexisting mental illness. High rates of common mental disorders have been documented after recent hurricanes. As hurricanes become increasingly severe, health care systems may expect to see more mental illness related to these extreme storms. Psychiatrists and allied health professionals can play vital roles in several areas: educating and preparing current caseloads of patients for possible storm impacts; intervening with persons who develop new-onset disorders after storm exposure; providing consultation to public health and community preparedness leadership about the mental health consequences of hurricanes; participating actively in community emergency response; and championing the integration of psychiatry with climate science and advocacy.

American Society of Clinical Oncology-recommended surveillance and physician specialty among long-term breast cancer survivors.

BACKGROUND: It is unclear whether it is appropriate to transfer the follow-up care of breast cancer (BrCa) survivors from cancer specialists to primary care physicians (PCPs). This contemporary study compared physician specialty and documented the long-term surveillance of survivors who underwent surgery at an American academic center. METHODS: Women in this institutional review board-approved study underwent breast surgery between 1996 and 2006. Data were collected for 270 patients with stage I to III BrCa (mean follow-up, 6 years). Charts were reviewed based on American Society of Clinical Oncology (ASCO) guidelines for recommended surveillance frequency and care. RESULTS: The majority of patients (90%; n = 242) were followed by specialists with 10% (n = 28) followed by PCPs. Patients with advanced disease and a greater risk of disease recurrence more often received specialist care. Patients followed by specialists were more often seen at ASCO-recommended intervals (eg, 89% vs 69% of patients followed by a PCP at follow-up Year 6; P < .01); however, many patients were followed inconsistently. Breast disease was often not the focus of PCP visits or mentioned in clinic notes (18% patients). Women seen by specialists were more likely to have documented clinical examinations of the breast (93% vs 44% at Year 6), axilla (94% vs 52%), or annual mammograms (74% vs 48%; P = .001-.02). CONCLUSIONS: Consistent compliance with surveillance guidelines and chart documentation needs improvement among all providers; however, specialists more consistently met ASCO guidelines. If transfer of care to a PCP occurs, it should be formalized and include follow-up recommendations and defined physician responsibilities. Providers and patients should be educated regarding surveillance care and current guidelines incorporated into standard clinical practice.