Walking Forward: The South Dakota Native American Project DANIEL G. PETEREIT, MD, DEBORAH ROGERS, LINDA BURHANSSTIPANOV, JUDITH KAUR, FRANK GOVERN, STEVE P. HOWARD, CHRISTEN H. OSBURN, C. NORMAN COLEMAN, JACK F. FOWLER, RICHARD CHAPPELL, MINESH P. MEHTA Abstract—Background. The “Walking Forward” program is a scientific collaborative program be- tween Rapid City Regional Hospital, the University of Wisconsin, the Mayo Clinic, and partner- ships with the American Indian community in western South Dakota—3 reservations and 1 urban population. The purpose is to increase participation of health disparities populations on National Cancer Institute clinical trials as part of the Cancer Disparities Research Partnership program. Clin- ical practice suggests that Native American cancer patients present with more advanced stages of cancer and hence have lower cure rates and higher treatment-related morbidities. It is hypothesized that a conventional course of cancer treatment lasting 6 to 8 weeks may be a barrier. Methods. Therefore, innovative clinical trials have been developed to shorten the course of treatment. A mo- lecular predisposition to treatment side effects is also explored. Results and Conclusions. All of these clinical endeavors will be performed in conjunction with a patient navigator program. Research metrics include analysis of process, clinical trials participation, treatment outcome, and access to cancer care at an early stage of disease. J Cancer Educ. 2005; 20:65-70. T hat there are differential trends in cancer detection, treatment, clinical trials participation, and treat- ment outcomes between various US subpopulations has long been recognized. 1-4 The National Cancer Institute (NCI) has recently initiated a unique research program to evaluate and potentially redress this situation through com- munity-based hospitals partnering with comprehensive can- cer centers to target underserved populations. We describe the basic structure of this important program, “Walking For- ward,” which focuses on the Native American population in the region surrounding Rapid City, SD. CANCER DISPARITIES The burden of cancer is not borne equally by all popula- tion groups in the United States. The unequal burden is ex- emplified by differences in cancer morbidity and mortality as a function of gender, ethnicity, and socioeconomic status. Colorectal cancers among Alaska Native men and kidney cancer among southwestern American Indian men are high- er than those for any other racial or ethnic group. 4 In addi- tion to significant differences in morbidity and mortality, there are variables in treatment and patient comorbidities that influence outcome. Barriers to Quality Cancer Care There are numerous well-documented barriers that may influence the type of cancer care a patient receives: (1) lack of knowledge about state-of-the-art cancer care; (2) fear and distrust of the health care system; (3) lack of access to cancer care (not referred or unable to access due to finances, lack of child care, etc); (4) geographic isolation (travel distances); (5) socioeconomic factors such as age, education, income, family status, and lack of insurance; (6) gender and race (sexism and racism); (7) fear of diagnostic tests, treatment, and side effects (disfigurement, pain, nausea, etc); and (8) differing cultural views of health and disease processes. 5-7 These barriers and/or factors include structural factors that influence physician recommendations and patient deci- 65 Received from John T. Vucurevich Cancer Care Institute, Rapid City, South Dakota (DGP, DR); Department of Human Oncology, University of Wisconsin Comprehensive Cancer Center, Madison, Wisconsin (DGP, SPH, JFFMPM); Native American Cancer Research Corporation Pine, Colorado (LP); Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota (JK); Radiation Research Program, National Cancer Institute (FG, CNC); SAIC-Frederick, Inc., A Subsidiary of Science Applications International Corporation (CHO); Department of Biostatistics and Medi- cal Informatics, University of Wisconsin Comprehensive Cancer Center, Madison, Wisconsin (RC). Supported by National Institutes of Health Grant RFA 1U56CA99010-01. This project has been funded in part with Federal funds from the National Cancer Institute, National Institutes of Health under contract no. N01-CO-12400. Address correspondence and reprint requests to: Daniel G. Petereit, MD; John T. Vucurevich Cancer Care Institute, 353 Fairmont Boulevard, Rapid City, SD 57701; phone: (605) 719-2360; fax: (XXX) XXX-XXXX; e-mail: <dpetereit@rcrh.org>.