Department of Oncology, John T. Vucurevich Cancer Care Institute Rapid City, SD, USA.
Front Oncol. 2011 Jun 22;1:11. doi: 10.3389/fonc.2011.00011. eCollection 2011.
PURPOSE/OBJECTIVE(S): American Indians (AIs) present with more advanced stages of cancer and, therefore, suffer from higher cancer mortality rates compared to non-AIs. Under the National Cancer Institute (NCI) Cancer Disparities Research Partnership (CDRP) Program, we have been researching methods of improving cancer treatment and outcomes since 2002, for AIs in Western South Dakota, through the Walking Forward (WF) Program.
MATERIALS/METHODS: This program consists of (a) a culturally tailored patient navigation program that facilitated access to innovative clinical trials in conjunction with a comprehensive educational program encouraging screening and early detection, (b), surveys to evaluate barriers to access, (c) clinical trials focusing on reducing treatment length to facilitate enhanced participation using brachytherapy and intensity modulated radiotherapy (IMRT) for breast and prostate cancer, as AIs live a median of 140 miles from the cancer center, and (d) a molecular study (ataxia telangiectasia mutated) to address whether there is a specific profile that increases toxicity risks.
We describe the design and implementation of this program, summary of previously published results, and ongoing research to influence stage at presentation. Some of the critical outcomes include the successful implementation of a community-based research program, development of trust within tribal communities, identification of barriers, analysis of nearly 400 navigated cancer patients, clinical trial accrual rate of 10%, and total enrollment of nearly 2,500 AIs on WF research studies.
This NCI funded pilot program has achieved some initial measures of success. A research infrastructure has been created in a community setting to address new research questions and interventions. Efforts underway to promote cancer education and screening are presented, as well as applications of the lessons learned to other health disparity populations - both nationally and internationally.
与非美洲原住民相比，美洲原住民（AI）癌症晚期比例更高，因此癌症死亡率也更高。在美国国家癌症研究所（NCI）癌症差异研究伙伴关系（CDRP）计划下，我们自 2002 年以来一直在通过“前进之路（WF）”计划，研究改善 AI 在南达科他州西部癌症治疗和结果的方法。
材料/方法：该计划包括：（a）文化上量身定制的患者导航计划，帮助患者获得创新临床试验机会，并结合全面的教育计划鼓励筛查和早期发现；（b）评估获取障碍的调查；（c）临床试验，重点是通过近距离放射治疗和调强放疗（IMRT）减少治疗时间，促进参与度，因为 AI 居住的地方离癌症中心平均有 140 英里；（d）分子研究（共济失调毛细血管扩张突变），以确定是否存在增加毒性风险的特定特征。
我们描述了该计划的设计和实施、之前发表结果的总结，以及正在进行的研究以影响就诊时的分期。一些关键结果包括：成功实施了基于社区的研究计划、在部落社区内部建立信任、确定障碍、分析了近 400 名经过导航的癌症患者、临床试验入组率为 10%、以及 WF 研究中近 2500 名 AI 的总入组人数。
这个由 NCI 资助的试点计划已经取得了一些初步成功。在社区环境中建立了一个研究基础设施，以解决新的研究问题和干预措施。还介绍了正在进行的促进癌症教育和筛查的工作，以及将经验教训应用于其他健康差异人群（包括国内外）的情况。
