WSU study finds Native Americans have to travel farther for radiation therapy
Twa-le Abrahamson-Swan has seen how indigenous and rural communities are at a disadvantage when they need cancer treatment.
“Traveling even a short distance is very hard on the body,” said Abrahamson-Swan, an activist and Spokane tribesman whose mother, Deb Abrahamson, died of cancer in 2021. “They feel nauseous because of the treatment and need to have someone else drive them. This deters many people from seeking treatment. »
The problems are highlighted by a Washington State University study published in the journal Value in Health which found that people living in majority American Indian and Alaska Native neighborhoods have to walk about 40 miles more to get to the nearest radiotherapy facility than those living in the neighborhoods. dominated by other racial groups.
More than half of all American Indians and Alaska Natives live in small towns and rural areas, according to the study.
“We know that Native Americans have the worst outcomes once they’re diagnosed with cancer, and one of the reasons they may not be getting optimal treatment may have to do with access to treatment” said Solmaz Amiri, a professor specializing in geographic information systems who served as the study’s principal investigator with the Institute for Research and Education at WSU’s Elson S. Floyd College of Medicine to make advance community health. “Very few of these multimillion-dollar buildings housing radiation therapy facilities are located in rural areas and therefore cannot serve all populations.”
To identify the disparities, Amiri and her co-authors used a database of radiation therapy facility addresses and calculated the distance to the nearest facility for each group of blocks, a geographic unit used by the US Census Bureau which includes up to 3,000 people. The researchers then used data from the 2019 American Community Survey to compare travel distances by racial and ethnic composition. The study excluded Alaska and Hawaii due to major differences in travel habits in those states.
Comparing neighborhoods by racial majority and rurality, they found that travel distances for block groups with a majority of American Indians and Alaska Natives ranged between 26 and 103 miles, compared to a range 3 to 35 miles for block groups with other majority populations.
Amiri said breast and prostate cancers are most common in Indigenous communities.
“When it comes to prostate cancers and rectal cancers, people who have access to radiation therapy have better survival and lower mortality than people who don’t have access.”
These types of cancer can be treated with radiation therapy, but with the Indigenous community disproportionately affected by “radiation deserts,” they are also the most likely to undergo invasive surgeries that remove the cancers entirely to avoid financial bankruptcy and death. other complications.
Radiation treatments can take place several times a week, sending patients from their homes to the nearest hospital. For example, if an Aboriginal cancer patient lived on the Spokane Indian Reservation in Wellpinit, the drive to and from the regional care center in downtown Providence would take 2 hours and 15 minutes. This would bring a patient’s weekly commute to a total of 470 miles and nearly 16 hours of weekly commuting. Treatments last an average of six to eight weeks.
This can have a considerable physical impact on the patient.
To reduce travel costs, some may choose to relocate. “They are leaving the family and going to find accommodation in another town,” Amiri said. “This person doesn’t even have the emotional and psychological support that an ordinary cancer patient gets from their immediate family. This person has to go to treatment alone in a different environment that is unfamiliar to them.
Abrahamson-Swan said better access to preventative care is needed to catch cancers early. Her mother had several misdiagnoses before she was diagnosed with stage 4 cancer, she said. Abrahamson attributed his cancer to the radioactive uranium mines on the Spokane Reservation.
Patients may need to travel even farther to find a specialist for these rarer cancers, Abrahamson-Swan said.
Abrahamson-Swan continues to advocate for the creation of a holistic cancer center for tribal people in the area – an effort she started with her mother, who was inspired by the Salish Cancer Center on the Puyallup Reservation in Fife, Washington.
The Salish Cancer Center takes an integrative approach to treating the whole patient, combining conventional oncology with naturopathic care, administrative assistant Mikala McGlone said. A number of traditional Native healers from tribes across the United States visit the center to provide spiritual healing through various practices using sacred objects, herbs, songs or stories.
The center serves tribal and non-tribal members of the local community, as well as patients coming from long distances. To help those traveling for their appointments, the center offers discounted rooms at the Puyallup Tribe’s Emerald Queen Casino. However, most patient stays are short-term, as the center provides chemotherapy but not radiation therapy, McGlone said.
Cassie Lowe-Yee, an acupuncturist at the Salish Cancer Center, said many of her patients have to come out of their tribal health care system because they need to see multiple specialists such as surgeons, radiation oncologists and MRI facilities. or CT scan. Referrals take longer than normal and information does not always get back to their treating physician.
“It is difficult to coordinate care and manage side effects over longer distances, when prompt treatment is essential for effective cancer care,” Lowe-Yee said. “Having a cancer center like Salish in rural areas or on the east side of the mountain should help break down those barriers to care.”
One solution proposed by the researchers is to use mobile units to bring radiotherapy closer to patients. Moving the large equipment and linear accelerators that provide radiation therapy is a challenge, but the biggest hurdle is providing the large specialist staff that includes medical physicists, engineers and radiation therapists to administer the treatment.
The researchers also suggest strategically locating future radiation oncology centers.
“If we just put (another center) in another metropolitan area that already has one, that honestly won’t solve the problem,” Amiri said, “it will only exacerbate it.”
However, additional facilities in rural areas would still have staffing issues. Some rural practices have teams that rotate from site to site to cover more ground.
“In many places you can think of building a machine, but making it work is what’s hard,” said Lia Halasz, a radiation oncologist at the University of Washington who worked on the study. “On the other hand, I know these are issues that we should be working on as a pitch, because they are important issues to address.”
Improving transport and accommodation services might be the most practical solution.
“Trying to get patients into good care at this point seems more feasible,” Halasz said.
Patrick Johansson, director of the Northwest Health Education Research Outcomes Network at WSU’s College of Medicine, served as a co-investigator on the project. He created the survey for patients and healthcare providers to detail their radiation therapy experiences. Johansson advised using multiple research methods with both surveys and interviews with cancer patients and radiation therapy providers. Johansson highlighted the participation of those who refused or did not complete radiation therapy.
“If you only get people who have had treatment, you don’t get the full picture of people who may have refused treatment, so it’s a community engagement approach,” he said. declared.
Interviews identified specific barriers between Indigenous communities and access to radiation oncology services. This meant engaging with Indigenous tribes differently, including conducting inquiries at powwows and other Indigenous communion spaces.
WSU has partnered with Indigenous researchers such as Cole Allick, a member of the Turtle Mountain Band of Chippewa Indian Tribe, and studies community engagement in Indigenous health. For the WSU study, Allick based his questions on lived experience and the effects of isolation away from health care services.
“Growing up in North Dakota, if you need specialty care for something like cancer, I expect a few hours drive, the bare minimum,” Allick said. “That’s something that doesn’t get said when you look at the data that’s floating around with the cancer disparities that we face.”
Allick called Amiri’s decision to provide both health and geographic data “unique” because it provides cultural context to health inequalities in Indigenous communities. This, Allick said, will help identify where subsidies can be most effective.
“As far as funding agencies and different organizations are concerned, they want to see this type of data. This is an important first step to generate dialogue and come up with specific solutions to help us,” he said.
The researchers also looked at the lack of access to radiotherapy for rural communities in general. They found that Americans of all racial groups living in small towns and rural areas have to travel about 30 more miles than their urban counterparts.
Median travel distances to the nearest radiation therapy facility are 16 to 32 miles longer in small towns and rural block groups than in metropolitan block groups. Another study published in the International Journal of Radiation Oncology, Biology, Physics found that a subset of isolated rural census tracts representing 9.4 million Americans have at least one hour of additional commute time compared to to urban census tracts.
The picture is similar in Washington, where researchers investigated the same disparities in an earlier paper published last year.
Using Washington Department of Health mortality data based on people who died of cancer, they found that non-Hispanic American Indians and Alaska Natives would have had to walk an average of 19 miles in a direction to reach the nearest radiation therapy facility, whereas non-Hispanic white people would have had to travel, on average, 12 miles.
Those in nonmetropolitan counties lived an average of 35 miles from treatment centers and Native Americans in nonmetropolitan counties, 53 miles.