The Cancer Care Institute (CCI) in Rapid City, South Dakota, serves approximately 100,000 Native Americans from three reservations. Some patients live up to four hours from the cancer center. Identifying barriers which prevent Native Americans from presenting with earlier stages of cancer, or in some circumstances not at all, will be investigated. A culturally responsive questionnaire will be administered to randomly selected Native Americans on the reservation who do not have cancer. A second questionnaire will be given to cancer patients, and address similar issues, but concentrate on additional questions of oncologic relevance. It is hypothesized that a major barrier is geographic dislocation from cultural/community roots close to home. Traditional radiotherapy involves a 6 to 8 week course and daily treatments. This treatment approach may represent a major barrier. With the use of advanced technologies such as intensity modulated radiotherapy and brachytherapy, the treatment course can be shortened to 1 to 4 weeks. Therefore, to address this barrier, clinical trials have been developed which shorten treatment duration. A series of phase II studies are proposed for malignancies commonly seen among the Native Americans: metastatic disease, non-small cell lung (NSCLC), breast, prostate and head and neck (H and N) cancer. For patients with stage I and II breast cancer, high-dose-rate (HDR) brachytherapy will be substituted for a conventional course of external beam radiation. Patients with advanced prostate cancer will be treated with a 2 week course of conformal external beam radiation followed by an HDR implant in combination with androgen ablation. Pilot tomotherapy trials are proposed for patients with metastatic disease, locally advanced H&N, and NSCLC. The final pilot trial will investigate the use of HDR brachytherapy alone for early stage prostate cancer. A genetic milieu may exist which renders Native Americans more sensitive to radiation. Therefore, a laboratory study will be conducted to investigate whether Native Americans have a higher mutation rate of the AT (ataxia-telangiectasia) gene determined through HPLC of the peripheral blood lymphocytes. Through patient education, screening, assessing potential barriers to health care, and innovative treatment strategies, it is hoped that Native Americans will eventually present earlier in their disease process.
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