Walking Forward - American Indian Participation in Cancer Clinical Trials

描述(由申请人提供)： 这一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(AL)的高癌症死亡率，与美国总人口相比，这一死亡率高出30%。该项目的具体目标是：(1)利用患者导航(PN)服务的全面模式，改善目标人群中与癌症相关的下列健康结局：提高癌症筛查率；减少异常发现、癌症诊断和癌症开始治疗之间的延误，降低癌症出现的平均阶段，提高癌症存活率；以及(3)增加获得姑息治疗和其他服务的机会，以管理客户复杂的疾病状态。对这些努力的评价将采用“以利用为重点”的方法来记录进展情况并指导今后的努力。(2)进一步扩大癌症临床试验的范围，将更多的AI患者以及我们农村地区所有医疗服务不足的患者纳入NCI赞助的更常见癌症病点的临床试验。除了参加合作小组试验(如NCCTG、RTOG、GOG)外，还将开放Investigator发起的试验，如调强放疗和近距离放射治疗研究。还将开始参加威斯康星肿瘤学网络(Won)，以扩大该地区常见肿瘤研究的可获得性。(3)扩大目前翻译研究的范围，将放射基因组学包括在内，通过DNA微阵列识别可能预测治疗反应并最终指导治疗的基因，从而调查与辐射引起的AI患者毒性具体相关的遗传风险概况。这将包括比较照射后出现不良反应的患者和没有发生不良反应的患者对照射的淋巴细胞遗传反应。然后，可以开发出一种基因签名，在放射治疗之前识别易感患者。 与公共卫生相关：北部平原地区的美国原住民死于癌症的比率高于美国其他地区的人口。该项目将研究向美洲原住民提供援助的方法，以帮助解决阻止他们尽快接受癌症筛查、诊断和治疗以拯救生命的困难。

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.