The pervasive crisis of diminishing radiotherapy access for vulnerable populations in the united states – part 2: american indian patients

• Published in: Advances in radiation oncology 2017
• Main Authors: McClelland, Shearwood, MD, Leberknight, Jennifer, PhD, Guadagnolo, B Ashleigh, MD, MPH, Coleman, C Norman, MD, Petereit, Daniel G, MD
• Format: Article
• Language: English
• Subjects: Hematology, Oncology, and Palliative Medicine
• ISSN: 2452-1094; 2452-1094
• DOI: 10.1016/j.adro.2017.08.010

Abstract Introduction American Indian/Alaska Native (AI/AN) cancer patients disproportionally present with more advanced stages of disease and have the worst cancer-specific survival rates of any racial/ethnic group in the United States. The presence of disparities in radiotherapy (RT) access for AI/AN patients has rarely been examined. Methods The National Cancer Institute initiatives towards addressing AI/AN disparities were examined. Additionally, an extensive PubMed literature search for studies investigating RT access disparities in AI/AN patients was performed. Results The literature describing RT access disparities for AI/AN is sparse, revealing only three studies, each of which described initiatives from the Walking Forward program, the National Cancer Institute Cancer Disparity Research Partnership initiative to address AI/AN barriers to cancer screening among AI populations in the Northern Plains region (geographic remoteness and mistrust of healthcare providers). This program has utilized patient navigation, community education and access to clinical trials for over 4,000 AI/AN patients to combat high cancer mortality rates, and over the course of its fifteen years in existence, has resulted in patients presenting with earlier stages of disease and higher cure rates. Lung cancer, the most common cause of cancer-related mortality in AI/AN patients is the most recent and ongoing focus of the program. Conclusion The amount of information regarding RT access in AI/AN patients is limited, with nearly all peer-reviewed published progress in this area being associated with the Walking Forward program. Further initiatives from this program will hopefully inspire similar initiatives throughout the country in order to reduce the barriers to optimized cancer care that these patients face. Given the similarities with cancer disparities populations worldwide, the AI/AN experience should be included within the broad issue of global shortage of cancer care to underserved populations.