Cancer Survivorship Issues and Disparities Patterns, Quality of Care, Access, Clinical Trials
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1 Cancer Survivorship Issues and Disparities Patterns, Quality of Care, Access, Clinical Trials Linda Burhansstipanov, MSPH, DrPH President and Grants Director Native American Cancer Research 3022 South Nova Road Pine, CO ; These slides are dedicated in fond memory of our grandmother, friend and collaborator, Mary P. Lovato Santo Domingo Pueblo bone, leukemia, kidney cancers 1
2 This session is also dedicated to Eduard Gamito, dear friend and colleague Born 1962 Passed January 22, 2008 Dear Ed, we miss you and we honor you 3 Objective: By the end of this session, the participant will be able to: 1. Identify patterns and experiences of Native cancer patients that illustrate disparities and the unique needs of these and other medically underserved populations. (Information based on AIAN findings, but relates to several other communities) 4 2
3 Cancer Incidence (new cancer cases diagnosed each year per 100,000 Natives) and Mortality (cancer deaths each year per 100,000 Natives) 3
4 American Indians Alaska Natives (AIANs) living in Colorado Geographic Regions: ~43% of AIANs in CO live in Denver Metropolitan Area ~64% of AIAN nationally live off Reservation In Denver, ~18% migration to and from Reservation 7 American Indians Alaska Natives (AIANs) living in Colorado Geographic Regions (cont): 12% live on Southern Ute or Ute Mountain Ute Reservation Varies by cancer studies, but in general: ~35% from Northern Plains ~25% from Southern Plains ~30% from Southwest 8 4
5 Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research 5
6 Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research 6
7 Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research 7
8 Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research Espey, David K; Wo, Xiao-Chen; Swan Judith; Wiggins, Charles; Jim, Melissa A.; Ward, Elizabeth; Howe, Holly L.; Ries, Lynn A.G.; Miler, Barry A.; Jemal, Ahmedin; Ahmed, Faruque; Cobb, Nathaniel; Kaur, Judith S.; and Edwards, Brenda K. Annual Report to the Nation on the Status of Cancer, , Featuring Cancer in American Indians and Alaska Natives. Cancer [American 16 Cancer Society]: 2007 [ ]; Volume 110: No. 10. GRAPH MODIFIED BY Rick Clark, Native American Cancer Research 8
9 IHS Cancer Mortality (2008) Report erroneously states representation of 50+% of AIANs, but actually is ~18% of AIANs Includes common cancers or those with unique prevalence (stomach) Omits cancers that are changing in Indian Country (childhood) and throughout all races in US (brain) 17 Haverkamp D, Espey D, Paisano R, Cobb N., Cancer Mortality among AIAN: Regional Differences, , IHS, Rockville, MD
10 Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, Indian Health Service, Rockville, MD, February GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid) Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, Indian Health Service, Rockville, MD, February GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid) 10
11 Haverkamp D, Espey D, Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, Indian Health Service, Rockville, MD, February GRAPHS MODIFIED BY: Rick Clark, Native American Cancer Research (note horizontal grid) June Native Cancer Survivors -- All Cancers Sites Demographics and Logistics of AIAN Cancer Care 15.5% move back and forth between the Reservation and an urban (city) area 40% travel between 101 to 300 miles ONE WAY to obtain cancer care 12.4% traveled more than 300 miles ONE WAY to obtain cancer care
12 June Native Cancer Survivors - - All Cancers Sites About 1/3 have insurance (IHS is not now and never has been health insurance) Almost half (45.6%) had difficulties accessing cancer care IHS infrequently (18%) able to provide TIMELY referral to quality care (due to Congressional cuts to Contract Health Services) 23 Native Cancer Patients who also have Co- Morbidities Less than 10% recall ever being told about any clinical trial opportunities Co-morbidities: Diabetes = 50.6% High Blood Pressure = 45.4% Habitual Tobacco Use = 36% Obesity / Overweight = 30.7% Arthritis = 25.1% *HBP = ineligible for clinical trials, unless one-on-one negotiation with CT supporter Native American Cancer Education for Survivors NACES Preliminary Findings and Uses Native American Cancer Research ;
13 Clinical Trials and AIs AI cancer patients gradually becoming more involved with Clinical Trials Most within treatment trial than other phases or types of trials Most successful CT (WF) is Daniel Petereit, MD radiation side effects: Genetic marker more common within AIs 25 Palliative Care and AIAN Helping Hand (Christine DeCourtney, ANTHC) Northern Plains Palliative Care (Tinka Duran) Issues: Rural Hospice, Visiting Nurses Assn IHS/ and meds
14 Thank you for the Opportunity to Explain some of our Issues Other issues will be addressed in breakout session Breast-specific issues will be addressed in poster session Native American Cancer Research is very thankful for the good working relationship with the CDPHE
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