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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.

Today Walking Forward is a department of Avera Cancer Institute Center for Precision Oncology.

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 Navigation: Provide culturally responsive navigation services 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.

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

Promising Outcomes

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 plans to step beyond cancer treatment issues and encourage American Indians of western South Dakota to focus on all health issues throughout the continuum.

Published Articles & Research Studies

View recent articles and research studies published by Dr. Petereit. For a complete list, contact Kristine Williams.

  • Brower JV, Forman JD, Kupelian P, Petereit DG, Gondi V, Lawton CA, Anger NJ, Saha S, Chappell R, Ritter MA, "Quality of life outcomes from a dose-per-fraction escalation trial of hypofractionation in prostate cancer," Radiotherapy and Oncology 118(1): 99-104,·Jan 2016.
  • Coleman CN, Formenti SC, Chao N, Grover S, Rodin D, Petereit DG, Vikram B, Pistenmaa DA, Mohiuddin M, Williams TR, "The International Cancer Expert Corps (ICEC): Implementing a global force to address the catastrophic rise in cancer in the developing world," Radiotherapy and Oncology, 118: 127, Feb 2016.
  • Petereit D, Omidpanah A, Boylan A, Kussman P, Baldwin D, Banik D, Minton M, Eastmo E, Clemments P, Guadagnolo A, "A Multi-faceted Approach to Improving Breast Cancer Outcomes in a Rural Population, and the Potential Impact of Patient Navigation," South Dakota Medicine, Vol 69(6): 268-273, June 2016.
  • Coleman CN, Formenti SC, Chao N, Grover S, Rodin D, Petereit DG, Vikram B, Pistenmaa DA, Mohiuddin M, Williams TR, Wendling N, Roth L, Gospodarowicz M, Jaffray D, "Establishing global health cancer care partnerships across common ground: building on nuclear security, cancer disparities, education and mentorship," San Francisco, CA, CUGH Consortium of Universities for Global Health: Conference Presentation, Apr 11, 2016.
  • Guadagnolo, BA, Petereit DG, Coleman CN, "Cancer care access and outcomes for American Indian populations in the US: challenges and models for progress," Seminars in Radiation Oncology, in press, 2017.

Contact Us

Walking Forward seeks to address significant disparities in cancer care and outcomes between American Indian and non-American Indian populations throughout South Dakota. Call us today to learn more.


Goals of Walking Forward

Through research and outreach, Walking Forward aims to:

  • Increase cancer screening
  • Increase detection of cancers at an earlier stage
  • Increase cancer survival rates
  • Improve the quality of life for American Indian cancer patients

Live Better. Live Balanced. Avera.

Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

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