Abstract IA11: Understanding the complex factors that contribute to the persistence of disparities among American Indian/Alaska Native populations: The Walking Forward experience
Authors: Petereit Daniel G. 
Published: October 2015

Abstract
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 Cancer Disparities Research Partnership Program (CDRP), 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 1) 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 as AIs live a median of 140 miles from the cancer center, d) a molecular study (ATM - Ataxia telangectasia mutation) to address whether there is a molecular profile that increases toxicity risks, and e) recently funded projects using mHealth (mobile) technology to address smoking cessation in the general population and cancer survivors, as well as a survivorship program to increase physical activity. A breast patient navigation (BPN) program was developed for all patients in 2007 to address the high mastectomy rates in our area. An analysis of this program was undertaken to determine if the breast conservation rates (BC) have improved over time: 849 non-navigated patients from 2000-2006 were compared to 617 navigated patients from 2007-2012.
Results: To date, over 3,800 AIs have participated in various WF research studies. Critical outcomes include the establishment of trust within tribal communities, identification of barriers to cancer screening, creation of research infrastructure, higher completion rates and patient satisfaction for patients undergoing cancer treatment, enrollment of patients on Phase II trials with excellent clinical outcomes, and the establishment of new research partners. The BC rates have improved from 37% to 56% over time. To date, 158 AIs have been enrolled in our smoking cessation study with an anticipated accrual of 256. Recent analysis suggests that AI cancer patients with screen-detectable cancers are now presenting with earlier stages of disease and higher cure rates.
Conclusions: 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. One critical objective of the CDRP program was to create sustainable, community research programs that has been achieved at our site and is ongoing with new grants and a new partnership with the Avera Health in Sioux Falls, SD, where a genomics program will be implemented. Lessons learned will also be presented.
This study was funded by NIH grant 5 U56 CA099010.
Contributors: Sheikh Iqbal Ahamed2, Amy Boylan1, Simone Bordeaux1, Linda Burhansstipanov3, Kristin Cina1, Kim Crawford1, Mark Dignan6, Ashleigh Guadagnolo5, Linda Krebs3, Patricia Kussman1, Adam Omidpanah4, Daniel Petereit1, Michele Sargent1, Mary Stein1, Doris Thibeault1. 1Rapid City Regional Hospital, Rapid City, SD; 2Marquette University, Milwaukee, WI; 3Native American Cancer Research Corporation, Pine, CO; 4University of Washington, Seattle, WA; 5The University of Texas MD Anderson Cancer Center, Houston, TX; 6University of Kentucky, Lexington, KY.
Citation Format: Daniel G. Petereit. Understanding the complex factors that contribute to the persistence of disparities among American Indian/Alaska Native populations: The Walking Forward experience. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA11.