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The goal of this secondary data analysis is to explore the impact of concurrent exposure to COVID-19 and earthquakes on psychological distress and symptom burden among Puerto Rican cancer survivors. Methods: This secondary data analysis (n = 101) was part of a longitudinal case\u2013control cohort study (n = 402) aimed at describing unmet psychological needs among Puerto Rican cancer patients and non-cancer subjects previously exposed to Hurricane Mar\u00eda in 2017. The research team pooled data from participants (cancer survivors and non-cancer group) from their baseline assessments and from follow-up assessments conducted during January\u2013July 2020 (earthquake and the lockdown period). A descriptive, paired t-test, non-parametric mean rank test, and two-sided Pearson correlation analyses were performed. Results: Psychological distress and cancer symptom burden diminished over time. Resilience was significantly correlated with all the psychological and symptom burden variables during both pre- and post-earthquake and COVID-19 assessment periods. Conclusions: The results support the role of resilience, social support, and post-traumatic growth as potential protective factors preventing psychological distress and diminishing cancer symptom burden among cancer survivors exposed to natural disasters and the COVID-19 pandemic.<\/jats:p>","DOI":"10.3390\/ijerph21091237","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T04:59:54Z","timestamp":1726721994000},"page":"1237","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Hispanic Cancer Survivors Exposed to Multiple Natural Disasters: Pre\u2013Post-Disaster Changes in Anxiety, Depression, PTSD, Perceived Stress, and Physical Symptom Burden"],"prefix":"10.3390","volume":"21","author":[{"given":"Eida M.","family":"Castro-Figueroa","sequence":"first","affiliation":[{"name":"Clinical Psychology Department, School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico"},{"name":"School of Medicine, Ponce Health Sciences University, Ponce 00716, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3495-5991","authenticated-orcid":false,"given":"Cristina","family":"Pe\u00f1a-Vargas","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Rodr\u00edguez-Santiago","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Puerto Rico-Medical Sciences Campus, San Juan 00935, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan I.","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Biomedical Sciences Department, School of Medicine, Ponce Health Sciences University, Ponce 00716, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6270-0326","authenticated-orcid":false,"given":"Ruthmarie","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14627, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zindie","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7353-3711","authenticated-orcid":false,"given":"Heather","family":"Jim","sequence":"additional","affiliation":[{"name":"Moffitt Cancer Center, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Pereira","sequence":"additional","affiliation":[{"name":"Battle Creek VA Medical Center, Battle Creek, MI 49037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0745-7703","authenticated-orcid":false,"given":"Normarie","family":"Torres-Blasco","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00716, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idhaliz","family":"Flores","sequence":"additional","affiliation":[{"name":"Biomedical Sciences Department, School of Medicine, Ponce Health Sciences University, Ponce 00716, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0942-5657","authenticated-orcid":false,"given":"Rosario","family":"Costas-Mu\u00f1iz","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9081-5339","authenticated-orcid":false,"given":"Guillermo N.","family":"Armaiz-Pena","sequence":"additional","affiliation":[{"name":"Biomedical Sciences Department, School of Medicine, Ponce Health Sciences University, Ponce 00716, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"key":"ref_1","first-page":"79","article-title":"Geographies of vulnerability: A research note on human system adaptations to climate change in the Caribbean","volume":"120","author":"Robinson","year":"2020","journal-title":"Geogr. 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