# Presentation: 531990

## CDRP UpdateRapid City/University Wisconsin 

***Minesh Mehta, MD***
***Daniel G. Petereit, MD***
**University of Wisconsin Medical School**

- RTOG June 2006
- Philadelphia, PA

## Rapid City/UW Update

- Patient Navigation
- Surveys
- Community survey
- Cancer survey
- Clinical trials
- Cooperative Group Trials
- CDRP:  brachytherapy, tomotherapy
- ATM
- Analysis of program

## Patient Navigation (PN)

- Protocol open June 2004 (official start date grant)
- Provide support and some financial assistance
- 149 AIs undergone PN
- Overall median number of contacts:  5 (0-85)
- Radiation patients: 19 (0-59)
- Patient Navigator database to be analyzed
- Shannon Sparks, PhD
- University of Wisconsin

## Surveys 

- A Community Survey to Identify and Document the Barriers to Timely and Effective Cancer Screening, Diagnosis and Treatment for the Native American Community
- Opened in June 2004 – 604 of 1,000 completed
- Cancer patient survey:  investigate whether there is a correlation between attitudes and beliefs towards cancer AND stage at presentation
- 99 of 200 completed
- Partial analysis underway
- Consultant Ashleigh Guadagnolo, MD
- JCRT resident, now at MDAH

## Community Survey Preliminary Results

- Based on 289 surveys:  presented ASTRO 2005
- Goal:  identify potential barriers early cancer RX & detection
- Hypothesis:  Cancer screening rates for prostate, breast  & cervical cancer positively correlate
- increased level of education
- greater knowledge about cancer
- positive perception regarding the chances of surviving cancer
- younger age
- Material and methods:
- CRR administered 1 hour interview

## Community Survey Preliminary Results

- Preliminary results indicate about half of adult Native Americans underwent cancer screening at least once
- Factors associated with cancer screening were greater knowledge about cancer and being female
- Results suggest an educational program on cancer and the importance of early detection and treatment could be effective in reducing cancer disparities for AIs
- Current analysis underway 600 surveys
- Rebecca Koscik, PhD
- University of Wisconsin

## Phase II Trial HDR Brachytherapy Stage I and II Breast Cancer

- Similar criteria as previous APBI RTOG trial
- 34 Gy/10 Fxs
- Endpoints:
- Evaluate the rate acute, late toxicities
- Efficacy, local control, cosmesis
- 15 pts enrolled out of 100 (3 AIs)
- Majority interstitial technique
- 1 G3 toxicity:  recurrent infection requiring drainage
- Mammosite technique
- 15 patients enrolled to date:  mainly interstitial technique

## Phase II Study High Dose Rate Brachytherapy Advanced Prostate Cancer 

- Patient eligibility:  intermediate, high-risk prostate cancer
- Androgen ablation:  6 to 12 months
- EBRT:  2.2 Gy X 16 over  15 treatment days, HDR 6.5 Gy X 3
- Endpoints:
- Evaluate the rate acute, late toxicities
- Efficacy HDR boost
- 4 patients enrolled (0 AIs) out of 100
- No G3 toxicities
- Low accrual because of tomotherapy trial
- Considering changing HDR FX from 6.5 x 3, to 9 Gy x 2  to increase accrual by eliminating need for hospitalization

## TOMOTHERAPY PROSTATE TRIAL

- Phase I/II Hypofractionation Trial

- Multi-institutional Phase I/II trial (PI:  Mark Ritter, MD, PhD)
- -Level I/II completed (2006 ASTRO abstract)
- -160 patients: No G3 toxicities
- Rapid City:  26 patients enrolled (2 AIs) minimal toxicities, no G3
- -Most rapidly accruing trial every opened
- 	Level I nearly completed in Rapid City

## ATM MUTATIONS in Native Americans: Possible Association with Cancer and Radiotherapy Toxicities

- To determine the association between ATM heterozygosity and sensitivity to radiation
- 35 patients, 10 American Indians
- Gene sequencing underway
- Amy Moser, PhD

## Cooperative Group Trials, Total Number

- RTOG, NCCTG, ECOG, NSABP, others
- 2004-05
- 41 total
- 5 AIs (4 treatment, 1 cancer prevention)
- 2005-06
- 52 total
- 1 AI
- Total number of American Indians entered on trials since program opened:  June 2004
- Cancer Survey:  20
- General Survey:  604
- ATM: 10
- CDRP treatment trials:  5
- Cooperative Group Trials: 6
- TOTAL:  645
- Number of AIs on clinical trials nationally:  7
- AACR 2006:

***TELESYNERGY® ******Redeployment***

- -The TELESYNERGY® system (TS) at the University Wisconsin was redeployed to Pine Ridge Hospital May 2006
- -Plans underway to rapidly increase TS use
- -Ultimate goal:  increase access to health careAmerican Indians

- Rapid City

- Pine Ridge Hospital

## Manuscripts

- Petereit DG, Rogers D, Govern F, et al.  Increasing access to clinical cancer trials and emerging technologies for minority populations: the Native American Project.  J Clin Oncol. 2004 Nov 15;22(22):4452-5
- Rogers D, Petereit DG.  Cancer Disparities Research Partnership In Lakota Country: Clinical Trials, Patient Services And Community Education For The Oglala, Rosebud And Cheyenne River Sioux Tribes.  American Journal of Public Health 95 (12):1-4; 2005
- Petereit DG, Rogers D, Burhansstipanov L, et al.  Walking Forward:  The South Dakota Native American Project.  Journal of Cancer Education 20 (supplement) 65-70; 2005
- Petereit DG.  Maintaining And Acquiring Brachytherapy Skills.  Journal of American College of Radiology Jun 20  9:38-40;2005
- Eastmo E, Petereit DG.  Accelerated Partial Breast Irradiation: Expanding Options for Breast Preservation.  Advance for Imaging and Oncology,  November 91-95; 2005.

## Abstracts / Book Chapters

- Petereit DG, Rogers D,  Helbig P et al.  Cancer Screening Behavior In A Native American Population.  Int J Radiat Oncol Biol Phys. 63 (2 supplement 1); S445, 2005.
- Petereit DG.  Methods to Address Cancer Disparities for Native Americans in Western, South Dakota.  Proceeding of the 97th Annual Meeting of the American Association for Cancer Research (AACR).  Abstract #FO 01-02, page 1354, 2006.
- Bradley KA, Petereit DG:  Radiation Therapy For Gynecologic Malignancies.  Hematology/Oncology Clinics of North America (In Press 2006)
- Viswanathan AN, Petereit D.  Gynecologic Brachytherapy.  In:  Devlin P, editor.  Brachytherapy:  Techniques and Applications.  Lippincott, Williams and Wilkins, (In Press 2006)
- Burhansstipanov, L Petereit, DF  Genetics and Ethics in Nursing--New Questions in the Age of Genomic Health (In press 2006)

## Analysis of Program/Future Plans

- Community Survey
- Analysis of 600 surveys underway
- Rebecca Koscik, PhD
- Post-patient navigation analysis
- Some post PN questions in cancer survey
- New survey nearly complete
- Shannon Sparks, PhD
- Analysis of “softer” endpoints such as trust
- Shannon Sparks, PhD
- CT colonography project
- PIs:  Paul Limburg, MD  Mayo Clinic, Daniel Petereit Rapid City
- Hypothesis:  is a minimally prepped colon via CT colonograpy as sensitive as colonoscopy in the detection of polyps _>_ 7 mm in asymptomatic AIs > 50 yrs old
- Grant will be submitted 7/1/06