Search protocol of the SLR.

Background
The contemporary world is challenged by natural disasters accelerated by climate change, affecting a growing world population. Simultaneously, cancer remains a persistent threat as a leading cause of death, killing 10 million people annually. The efficacy of radiotherapy, a cornerstone in cancer treatment worldwide, depends on an uninterrupted course of therapy. However, natural disasters cause significant disruptions to the continuity of radiotherapy services, posing a critical challenge to cancer treatment. This paper explores how natural disasters impact radiotherapy practice, compares them to man-made disasters, and outlines strategies to mitigate adverse effects of natural disasters. Through this analysis, the study seeks to contribute to developing resilient healthcare frameworks capable of sustaining essential cancer treatment amidst the challenges posed by natural disasters.
Method
We conducted a Structured Literature Review to investigate this matter comprehensively, gathering and evaluating relevant academic publications. We explored how natural disasters affected radiotherapy practice and examined the experience of radiotherapy centres worldwide in resuming operations after such events. Subsequently, we validated and extended our research findings through a global online survey involving radiotherapy professionals.
Results
The Structured Literature Review identified twelve academic publications describing hurricanes, floods, and earthquakes as the primary disruptors of radiotherapy practice. The analysis confirms and complements risk mitigation themes identified in our previous research, which focused on the continuity of radiotherapy practice during the COVID-19 pandemic. Our work describes nine overarching themes, forming the basis for a taxonomy of 36 distinct groups. The subsequent confirmative online survey supported and solidified our findings and served as a basis for developing a conceptual framework for natural disaster-resilient radiotherapy as well as a checklist for practitioners.
Discussion
The growing threat posed by natural disasters underscores the need to develop business continuity programs and define risk mitigation measures to ensure the uninterrupted provision of radiotherapy services. By drawing lessons from past disasters, we can better prepare for future hazards, supporting disaster management and planning efforts, particularly enhancing the resilience of radiotherapy practice. Additionally, our study can serve as a resource for shaping policy initiatives aimed at mitigating the impact of natural hazards.