Walking forward - American Indian Participation in Cancer Clinical Trials

这项倡议的主要目标是解决并有望减少高，不祥的增长，癌症 南达科他州西部的美洲印第安人（Als）的死亡率，与 是美国总人口的两倍。该项目的具体目标是： (1)利用患者导航（PN）服务的综合模型，改善以下癌症相关 我们目标人群的健康结果：提高癌症筛查率;减少 异常发现、癌症诊断和开始癌症治疗，以减少 提高癌症存活率，并增加获得姑息治疗和其他服务的机会， 管理我们客户的复杂疾病状态。对这些努力的评价将采用“以利用为重点”的方法， 记录进展情况并指导今后工作的方法。 (2)进一步扩大癌症临床试验的范围，招募更多的人工智能患者，以及所有的医学研究。 在我们的农村地区，NCI赞助的临床试验，为更常见的癌症疾病的网站。 除了参与合作组试验（例如NCCTG、RTOG、GOG）外，研究者发起的试验 例如调强放射治疗和近距离放射治疗研究。参与威斯康星州肿瘤学网络 (WON)还将启动以扩大对中更常见肿瘤的研究的可用性 这方面 (3)扩大当前转化研究的范围，包括放射基因组学， 通过识别基因，确定AI患者中与辐射诱导毒性特别相关的遗传风险概况 通过DNA微阵列来预测治疗反应并最终指导治疗。这将 包括比较有不良反应患者对辐射的淋巴细胞遗传反应 对那些没有辐射的人进行辐射。然后可以开发一种基因签名， 在放射治疗前对易感患者进行治疗。

The primary goal ofthis initiative is to address and hopefully reduce the high, and ominously increasing, cancer mortality rates among American Indians (Als) in western South Dakota, which is 30% higher as compared to that ofthe overall US population. The specific aims ofthis project are: (1) to utilize a comprehensive model of patient navigation (PN) services to improve the following cancer-related health outcomes in our target population: to increase cancer screening rates; to decrease delays between abnormal finding, cancer diagnosis and initiation of cancer treatment, to decrease the average stage at which cancer presents, to increase cancer survival rates, and to increase access to palliative care and other services to manage the complex disease states of our clients. Evaluation of these efforts will employ a "utilization -focused" methodology to document progress and guide future efforts. (2) to further expand the scope of chnical cancer trials and to enroll more AI patients, as well as all medically underserved patients in our rural area, to NCI sponsored clinical trials for the more common cancer disease sites. In addition to participation in Cooperative Group trials (e.g. NCCTG, RTOG, GOG), Investigator initiated trials such as IMRT and brachytherapy studies will be opened. Participation in the Wisconsin Oncology Network (WON) will also be initiated to broaden the availability of studies for the more common tumors that are seen in this area. (3) to expand the scope of current translational research to include radiogenomics that will allow investigating the genetic risk profiles specifically related to radiation induced toxicities among AI patients by identifying genes through DNA microarrays that might predict response to treatment and ultimately guide therapy. This would include comparing lymphocytic genetic responses to irradiation from patients who had adverse reactions following irradiation to those who have not. A genetic signature could then be developed that would identify susceptible patients prior to radiation therapy.