Walking Forward - American Indian Participation in Cancer Clinical Trials

描述（由申请人提供）： 该倡议的主要目标是解决并有望降低南达科他州西部美洲印第安人（Als）的癌症死亡率，该死亡率比美国总人口高30%。该项目的具体目标是：（1）利用患者导航（PN）服务的综合模式，改善我们目标人群的以下癌症相关健康结果：提高癌症筛查率;减少异常发现、癌症诊断和开始癌症治疗之间的延迟，降低癌症出现的平均阶段，提高癌症存活率，并增加获得姑息治疗和其他服务的机会，以管理我们客户的复杂疾病状态。对这些努力的评价将采用“注重利用”的方法，以记录进展情况并指导今后的努力。(2)进一步扩大临床癌症试验的范围，招募更多的AI患者，以及我们农村地区所有医疗服务不足的患者，参加NCI赞助的针对更常见癌症疾病的临床试验。除了参与合作组试验（如NCCTG、RTOG、GOG）外，还将开放研究者发起的试验，如IMRT和近距离放射治疗研究。参与威斯康星州肿瘤学网络（WON）也将启动，以扩大在这一领域看到的更常见的肿瘤的研究的可用性。(3)扩大目前转化研究的范围，包括放射基因组学，这将允许通过DNA微阵列识别基因，从而研究与AI患者中辐射诱导毒性特别相关的遗传风险概况，这些基因可能预测对治疗的反应并最终指导治疗。这将包括比较淋巴细胞的遗传反应，辐射后有不良反应的患者和那些谁没有辐射。然后可以开发一种基因签名，在放射治疗之前识别易感患者。 公共卫生相关性：北方平原地区的美洲原住民死于癌症的比率高于美国其他人口。该项目将研究向美洲原住民提供援助的方式，以帮助解决阻碍他们尽快接受癌症筛查、诊断和治疗以挽救生命的困难。

DESCRIPTION (provided by applicant): The primary goal of this 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 of the overall US population. The specific aims of this 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 clinical 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 genetic risk profiles specifically related to radiation induced toxicity 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. PUBLIC HEALTH RELEVANCE: Native Americans in the Northern Plains region die from cancer at a higher rate than the rest of the US population. This project will study ways of providing assistance to Native Americans in order to help address the difficulties that prevent them from getting screened, diagnosed and treated for cancer soon enough to save lives.