June 22, 2022

Native Americans face disproportionate displacement

SPOKANE, Wash.—With higher rates of certain cancers than non-Hispanic whites, many Native Americans must travel particularly long distances to access radiation therapy, according to a study by researchers at Washington State University. .

Published in the journal Health valuethe study found that people living in American Indian and Alaska Native majority neighborhoods have to travel about 40 miles further to get to the nearest radiation therapy facility than those living in neighborhoods dominated by d other racial groups.

“Up to 60% of cancers require access to radiation therapy, which can only be administered in specialized institutions by qualified physicians,” said the study’s first author, Solmaz Amiri, assistant research professor at the WSU Elson S. Floyd College of Medicine and a researcher at the Institute for Research and Education to Advance Community Health (IREACH). “Since treatment regimens require visits once or twice a day for up to eight weeks, traveling to these facilities is a significant burden that becomes a significant barrier to treatment.”

As a result, she said, people seeking cancer treatment may choose more invasive surgeries, such as a mastectomy or complete breast removal, for breast cancer, instead of less invasive surgeries that require follow-up radiotherapy.

To identify these 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 based on racial and ethnic composition, area deprivation, and block group rurality.

Comparing neighborhoods by racial majority and rurality, they found that travel distances for groups of blocks 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.

The researchers also identified three US regions that were “radiation deserts” with longer than average travel distance for radiation therapy: one in the western United States that covers Oregon, Utah, Nevada and Arizona; another in the southern plains states of Colorado, Kansas, New Mexico and Oklahoma; and a third in the northern plains states of Montana, North Dakota, South Dakota and Nebraska, an area that had some of the longest travel distances and highest cancer rates between 2008 and 2017 Nearly a third of Native Americans and Alaska Natives lived in these radiation wastelands.

The researchers also found disparities between rural and urban communities, with Americans of all racial groups living in small towns and rural areas having to travel about 30 more miles than their urban counterparts. By some estimates, more than half of all American Indians and Alaska Natives live in small towns and rural areas.

“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” , Amiri said. “Very few of these multimillion-dollar buildings housing radiation therapy facilities are located in rural areas, so they cannot serve all populations.”

She suggested that policymakers consider the potential use of mobile radiation therapy facilities to help fill access gaps, which could improve disparities in cancer outcomes and mortality in Native American and Indigenous communities across the country. Alaska.

The first known study to examine racial disparities in travel distances to radiation therapy facilities in the United States, this study is part of a larger project to identify disparities in access to radiation oncology among populations American Indians and Alaska Natives and to seek solutions.

Support for the work comes from a Kuni Foundation grant to study co-authors Dedra Buchwald, professor of medicine at WSU, and Lia Halasz, associate professor and radiation oncologist at the University of Washington.


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