The National Institutes of Health has awarded the University of Oklahoma a five-year, $17.2 million grant to partner with tribal nations and communities to improve cancer outcomes. Research has shown that the American Indian and Alaska Native population in Oklahoma experiences a 36% higher incidence of cancer and a 73% higher death rate from cancer than faced by the U.S. general population.
This effort will leverage research strategies to address three priorities identified by tribal communities in Oklahoma: cancer prevention, cancer screening and cancer care coordination. The Native American Center for Cancer Health Equity (NACCHE) at OU Health Stephenson Cancer Center will lead the work of the grant, titled “Improving Cancer Outcomes in Native American Communities” (ICON).
“Cancer health disparities are particularly marked among Native communities in Oklahoma. This grant gives us a unique opportunity to build upon our partnerships with tribal nations and communities. They are guiding our work based on their needs, and together, we aim to improve cancer outcomes by building up their strengths and resilience,” said Dorothy Rhoades, M.D., MPH, principal investigator for the ICON grant. She is a professor of medicine at the OU College of Medicine and director of NACCHE.
Oklahoma has the second-highest population of American Indian and Alaska Native people in the United States and is home to 39 tribal nations. OU researchers will collaborate with 16 tribes and closely consult with a Tribal Advisory Council to establish best practices for reducing the burden of cancer.
“Sadly, tribal communities experience higher rates of cancer than other demographics. However, by increasing robust biomedical cancer research funding, we can work to improve cancer treatments and ultimately find a cure for not only tribal cancer patients, but all cancer patients,” said Congressman Tom Cole. “I am proud to have helped secure the University of Oklahoma a $17.2 million grant from the NIH, which will allow the University to partner with tribal nations to improve cancer outcomes. We must continue to utilize medical research to strengthen health care, combat diseases, and save lives – this grant will help to do just that.”
Increasing lung cancer screening
One of three sub-projects supported through ICON will establish a system for increasing lung cancer screening within the Cherokee Nation. Lung cancer is, by far, the leading cause of cancer death in Oklahoma, and rates are especially high – and still rising – among Native people, said ICON co-principal investigator Mark Doescher, M.D., MSPH, a professor of family medicine in the OU College of Medicine and associate director, Community Outreach and Engagement, for Stephenson Cancer Center.
Primary care physicians may suggest lung cancer screening for high-risk patients, but a coordinated, system-wide approach is needed to ensure screening takes place. Tobacco cessation support is also crucial for people who smoke.
“Lung cancer screening through a low-dose CT scan has been available and recommended for the past decade, but less than 10% of those eligible have undergone the screening,” Doescher said. “Research has shown that increasing lung cancer screening rates would be the single most effective cancer screening strategy we can use to avert deaths from cancer.”
Increasing access to screening will benefit the Cherokee Nation for generations to come, said Cherokee Nation Principal Chief Chuck Hoskin Jr. “As Cherokee people, we have always understood the importance of coming together to care for one another, and this groundbreaking partnership with OU represents a significant step in truly addressing the cancer disparities that we see within our tribe and other tribal nations,” Hoskin said. “Advanced medical research, when combined with traditional knowledge, can help deliver a healthier future for all Native people in Oklahoma. This effort strengthens our ability to fight cancer and brings more hope to Cherokee families.”
Care coordination
Patients diagnosed with cancer and referred to OU Health Stephenson Cancer Center are best served by a flow of information between the patient’s primary care provider and the cancer treatment team, which can involve surgery, radiation therapy and chemotherapy. To make decisions regarding the mutual health care needs of patients, the cancer treatment team needs to understand a patient’s medical history, and primary care providers should receive updates about the ongoing cancer treatment plan.
Through telehealth “huddles,” the project team from Stephenson Cancer Center, including a medical oncologist, will regularly exchange information with a corresponding patient support team at the patients’ medical homes within diverse tribal health systems. The huddles will also help identify resources to address financial hardships if, for example, a patient doesn’t have gas money to make it to medical appointments or can’t afford recommended nutritional supplements.
In addition, Stephenson Cancer Center’s American Indian Navigation Program will be integral to helping patients manage the complex logistical and cultural barriers that can arise upon referral for oncology care.
“We hope that these huddles reduce appointment no-shows, improve the time to treatment initiation, and improve patient satisfaction,” Rhoades said. “This model of communication has been common within hospitals, but this is novel to establish a model for communicating between different types of providers in separate locations.”
Water analysis
The final ICON project will assess levels of arsenic and uranium in drinking water in three regions – the Northern Plains, the Southern Plains (which includes Oklahoma) and Arizona. Historically, arsenic and uranium exposures have been much higher in Native communities compared to the rest of the U.S. population, caused by factors such as unregulated water supplies and uranium mining concentrated in tribal areas.
Water analysis will be led by researchers at Columbia University in New York, who have already worked with several tribes to develop water filtration interventions after high levels of arsenic and uranium were found. The research team will also analyze data from the Strong Heart Study, which has investigated cardiovascular risk factors among Native Americans for many years, with a major focus on Oklahoma. The study collected basic information about cancer diagnoses, which researchers plan to link with cancer registries across the nation.
“We know that arsenic and uranium are associated with cancer,” Rhoades said. “This effort will involve outreach to tribal communities in southwest Oklahoma. We will be looking for evidence that these heavy metals are influencing cancer rates, and if that’s what we find, we will help develop interventions to reduce those exposures.”
Deepening partnerships
The ICON study will build upon more than a decade of collaboration between OU, tribal nations and their health systems, urban Indian health facilities and the Indian Health Service. OU faculty and staff from the Center for Applied Social Research, the Center for the Ethics of Indigenous Genomic Research and the Institute for Community and Society Transformation have worked on Native American health initiatives for years.
“We are really excited about the opportunity to continue working with tribal communities to address cancer outcomes by conducting culturally respectful studies that engage tribes as full partners in the research enterprise,” said ICON co-principal investigator Paul Spicer, Ph.D., an OU professor of anthropology and a co-director at the Center for Applied Social Research.
Stephenson Cancer Center is one of only two National Cancer Institute-designated cancer centers to receive this grant. Since 2012, the cancer center’s Native American navigators have served more than 4,460 Native patients, representing 65 local, regional and national tribal affiliations. Stephenson Cancer Center researchers have collaborated with 29 tribal partners on 43 funded projects (41 funded by the NIH), totaling nearly $41 million.
“This new grant represents a milestone for Stephenson Cancer Center and for our patients across Oklahoma,” said Director Robert Mannel, M.D., a professor of obstetrics and gynecology in the OU College of Medicine. “We are honored to deepen our partnerships with tribal nations and communities to conduct research that ultimately reduces cancer disparities and improves health for generations to come.”
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About the project
The research reported in this news release is supported by the National Institute on Minority Health and Health Disparities, a component of the National Institutes of Health, under award number 1U19MD020537-01. The content of this news release is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.