McClelland Shearwood, Leberknight Jennifer, Guadagnolo B Ashleigh, Coleman C Norman, Petereit Daniel G
Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon.
Walking Forward Program, Rapid City, South Dakota.
Adv Radiat Oncol. 2017 Aug 26;3(1):3-7. doi: 10.1016/j.adro.2017.08.010. eCollection 2018 Jan-Mar.
American Indian/Alaska Native (AI/AN) patients with cancer 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 radiation therapy (RT) access for AI/AN patients has rarely been examined.
National Cancer Institute (NCI) initiatives toward addressing AI/AN disparities were examined. Additionally, an extensive PubMed literature search for studies investigating RT access disparities in AI/AN patients was performed.
Literature describing RT access disparities for the AI/AN patient population is sparse, revealing only 3 studies, each of which described initiatives from the Walking Forward program, the NCI Cancer Disparity Research Partnership initiative to address barriers to cancer screening among AI populations in the Northern Plains region (eg, geographic remoteness and mistrust of health care providers). This program has used patient navigation, community education, and access to clinical trials for more than 4000 AI/AN patients to combat high cancer mortality rates. Over the course of its 15-year existence, the program has resulted in patients presenting with earlier stages of disease and experiencing 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.
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 to reduce the barriers to optimized cancer care that these patients face. Given the similarities with cancer disparities of populations worldwide, the AI/AN experience should be included within the broad issue of a global shortage of cancer care among underserved populations.
美国印第安人/阿拉斯加原住民（AI/AN）癌症患者所患疾病往往处于更晚期阶段，且其癌症特异性生存率在美国所有种族/族裔群体中是最差的。针对AI/AN患者在放疗（RT）可及性方面存在的差异，此前很少有人进行研究。
对美国国立癌症研究所（NCI）为解决AI/AN差异问题所采取的举措进行了研究。此外，还在PubMed上进行了广泛的文献检索，以查找有关AI/AN患者放疗可及性差异的研究。
描述AI/AN患者群体放疗可及性差异的文献很少，仅发现3项研究，每项研究都描述了“携手前行”项目、NCI癌症差异研究合作项目为解决大平原地区AI人群癌症筛查障碍（如地理位置偏远和对医疗服务提供者的不信任）所采取的举措。该项目通过患者导航、社区教育以及为4000多名AI/AN患者提供临床试验机会，来应对高癌症死亡率问题。在其15年的实施过程中，该项目使患者所患疾病处于更早期阶段，并提高了治愈率。肺癌是AI/AN患者癌症相关死亡的最常见原因，也是该项目最新且持续关注的重点。
关于AI/AN患者放疗可及性的信息有限，该领域几乎所有经过同行评审发表的进展都与“携手前行”项目有关。希望该项目的进一步举措能激发全国范围内的类似举措，以减少这些患者在获得优化癌症治疗方面面临的障碍。鉴于全球范围内未得到充分服务人群的癌症差异情况相似，AI/AN人群的经历应纳入全球癌症护理短缺这一广泛问题之中。
