Walking Forward – Cancer Research for American Indians
American Indians on the Northern Plains have one of the highest rates of cancer deaths in the United States. That’s why, in 2002, Walking Forward was created through a National Cancer Institute community cancer grant with radiation oncologist Daniel Petereit, MD, as its principal investigator.
Community Cancer Services for American Indians
To accomplish its mission, Walking Forward provides a variety of cancer-related services to tribal communities:
- Cancer Education: Increase knowledge about the causes of cancer and related health issues through community discussions and workshops to address concerns and misconceptions surrounding diagnosis, treatment and survivorship.
- Community Patient Navigation: Provide culturally responsive navigation services – from registered nurses and licensed practical nurses – to guide American Indians through the complexity of cancer care.
- Cancer Screening: Increase cancer screening rates by educating about the availability and benefits of cancer screening and navigation to these services and resources.
- Earlier Diagnosis: Increase patient survival rates by earlier detection and presentation of cancer (stage migration), earlier treatment, and ultimately a better outcome.
- Clinical Trials: Increased enrollment in clinical trials by educating about clinical trial opportunities and encouraging participation.
Lung Cancer Initiatives
According to the American Cancer Society, lung cancer is the number one cause of cancer-related deaths in the U.S. and South Dakota. In addition, smoking rates among American Indian communities throughout the state exceed 50 percent. For these two reasons, Walking Forward has dedicated much of its research and efforts over the past 15 years to lung cancer initiatives, including:
- Smoking cessation project to identify effective methods to help American Indians quit smoking. This study included 256 American Indians who were randomized to four interventions: nicotine replacement, pre-cessation counseling, post-cessation counseling and mHealth text reminders.
- Low-dose computed tomography (LDCT) scan screenings to diagnose lung cancer at an earlier stage.
- Online assessment tool to identify candidates for LDCT screenings.
- Genetics study to identify a molecular marker for lung cancer among American Indian lung cancer patients that could be used to develop a blood test for lung cancer screening.
From education and early detection screening to advanced diagnostics and innovative cancer care, Walking Forward is dedicated to empowering the American Indian community with the services they need to prevent and treat lung cancer.
Barriers & Challenges to Overcome
In-depth community research provided insights about barriers to cancer care that exist within the demographics of western South Dakota, including:
- Additional costs associated with treatment such as gas, food and lodging
- Average travel distance to cancer care is 145 miles one way
- Cultural beliefs regarding medical treatment
- Home to four of the top 10 poorest counties in the U.S., with poverty rates over 45 percent
- Negative attitudes and mistrust toward local caregivers
Despite the challenges, Walking Forward has achieved success as evident from measured outcomes over the last several years, such as:
- Created research infrastructure including new research partners
- Higher completion rates for treatment, which often leads to higher survival rates
- Higher participation rate in clinical trials with over 4,000 American Indian participants to date
- Increased trust among the tribal community
- Integrating patient navigators into each Indian Health Service facility in South Dakota
Recent data analysis suggests that cancer patients with screen-detectable cancers are now presenting with earlier stages of disease and experience higher cure rates.
In the future, Walking Forward hopes to step beyond cancer issues and encourage American Indians of western South Dakota to focus on all health issues, such as smoking cessation, diabetes, and obesity since many of these conditions also increase the risk of cancer.