Native Americans face disproportionate travel burden for cancer treatment – WSU Insider

Spokane, Washington. With higher rates of certain cancers than non-Hispanic whites, many Native Americans have to travel particularly long distances to access radiotherapy, according to a study led by researchers from Washington State University.

The study, published in the journal Value in Health, found that individuals who live in American neighborhoods with a majority of American Indians and Alaska Natives have to travel 40 miles to the nearest radiotherapy facility than those who live in neighborhoods dominated by other ethnic groups.

Study first author Solmaz Amiri, associate professor at WSU Elson S. School of Medicine and a researcher at the Institute for Research and Education for the Advancement of Community Health (IREACH) said. “Given that treatment regimens require a visit once or twice daily for up to eight weeks, access to these facilities is such a significant burden that becomes an important barrier to treatment.”

As a result, she said, people seeking cancer treatment may opt for more surgeries — such as a mastectomy, or total mastectomy for breast cancer — rather than less invasive surgeries that require follow-up radiotherapy.

To determine these disparities, Amiri and her colleagues used a database of addresses for radiotherapy facilities and calculated the distance to the nearest facility for each block group, a geographic unit used by the US Census Bureau that 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 makeup, area deprivation, and the prevalence of cluster groups.

Comparing neighborhoods by ethnic majority and rurality, they found that travel distances for block groups with American Indians and majority Alaskan Natives ranged from 26 to 103 miles, compared to a range of 3 to 35 miles for other majority block groups.

The researchers also identified three US regions where “radiation deserts” were longer than the average travel distance for radiotherapy: an area in the western United States covering Oregon, Utah, Nevada and Arizona. and 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 with some of the longest travel distances and the highest rates of cancer between 2008 and 2017. Nearly a third of American Indians and Alaska Natives live in these radiotherapy deserts.

The researchers also found disparities between rural and urban communities, with Americans of any ethnic group living in small cities and rural areas having to travel about 30 miles more 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 are diagnosed with cancer, and one of the reasons they don’t get optimal treatment may be related to getting treatment,” Amiri said. “Very few of these multi-million dollar buildings housing radiotherapy facilities are located in rural areas and therefore cannot serve the entire population.”

She suggested that policy makers consider the potential use of ambulatory radiotherapy facilities to help close access gaps, which could improve disparities in cancer outcomes and mortality in American Indian and Alaska Native communities.

The first known study to investigate racial disparities in travel distances to US radiotherapy facilities, this study is part of a larger project to identify disparities in access to radiation oncology between American Indians and Alaska Natives and work to find solutions.

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

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