The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 2: American Indian patients.
The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 2: American Indian patients.
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DOI：
10.1016/j.adro.2017.08.010
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发表时间：
2018-01
影响因子：
2.3
通讯作者：
Petereit DG
中科院分区：
文献类型：
--
作者：
McClelland S 3rd;Leberknight J;Guadagnolo BA;Coleman CN;Petereit DG
美洲印第安人/阿拉斯加原住民 (AI/AN) 癌症患者不成比例地出现晚期疾病，并且在美国所有种族/族裔群体中癌症特异性生存率最低。 AI/AN 患者接受放射治疗 (RT) 方面存在的差异很少得到研究。对美国国家癌症研究所 (NCI) 解决 AI/AN 差异的举措进行了审查。此外，我们还对 AI/AN 患者接受 RT 差异的研究进行了广泛的 PubMed 文献检索。描述 AI/AN 患者群体 RT 获取差异的文献很少，仅披露了 3 项研究，每项研究都描述了“行走前进”计划的举措，即 NCI 癌症差异研究合作伙伴计划，旨在解决北部平原地区 AI 人群癌症筛查的障碍（例如，地理偏远和对医疗保健提供者的不信任）。该计划利用患者导航、社区教育和对 4000 多名 AI/AN 患者进行临床试验的机会来对抗高癌症死亡率。在其 15 年的存在过程中，该项目已使患者在疾病的早期阶段就诊并获得更高的治愈率。肺癌是 AI/AN 患者癌症相关死亡的最常见原因，也是该项目最新且持续关注的焦点。有关 AI/AN 患者接受 RT 的信息量有限，该领域几乎所有经过同行评审的已发表进展都与“前进”计划相关。该计划的进一步举措有望激发全国各地的类似举措，以减少这些患者在优化癌症护理方面面临的障碍。鉴于全球人口癌症差异的相似性，AI/AN 经验应纳入全球服务不足人群癌症护理短缺的广泛问题中。
American Indian/Alaska Native (AI/AN) patients with cancer disproportionally present with more advanced stages of disease and have the worst cancer-specific survival rates of any racial/ethnic group in the United States. The presence of disparities in radiation therapy (RT) access for AI/AN patients has rarely been examined. National Cancer Institute (NCI) initiatives toward addressing AI/AN disparities were examined. Additionally, an extensive PubMed literature search for studies investigating RT access disparities in AI/AN patients was performed. Literature describing RT access disparities for the AI/AN patient population is sparse, revealing only 3 studies, each of which described initiatives from the Walking Forward program, the NCI Cancer Disparity Research Partnership initiative to address barriers to cancer screening among AI populations in the Northern Plains region (eg, geographic remoteness and mistrust of health care providers). This program has used patient navigation, community education, and access to clinical trials for more than 4000 AI/AN patients to combat high cancer mortality rates. Over the course of its 15-year existence, the program has resulted in patients presenting with earlier stages of disease and experiencing higher cure rates. Lung cancer, the most common cause of cancer-related mortality in AI/AN patients, is the most recent and ongoing focus of the program. The amount of information regarding RT access in AI/AN patients is limited, with nearly all peer-reviewed published progress in this area being associated with the Walking Forward program. Further initiatives from this program will hopefully inspire similar initiatives throughout the country to reduce the barriers to optimized cancer care that these patients face. Given the similarities with cancer disparities of populations worldwide, the AI/AN experience should be included within the broad issue of a global shortage of cancer care among underserved populations.