For Dr. Dorothy Rhoades, a member of the Kiowa Tribe, working with Oklahoma’s tribal nations to address health disparities is “highly meaningful.”
Rhoades serves as the director of the Native American Center for Cancer Health Equity through the OU Health Stephenson Cancer Center. She is the principal investigator on a grant to improve cancer outcomes in tribal nations and communities.
That five-year grant — or the “Improving Cancer Outcomes in Native American Communities” (ICON) grant — will be used to partner with tribal nations to address prevention, screening and care coordination.
Grant priorities were identified through surveys developed with the cancer center’s tribal advisory council for Oklahoma’s Native communities. Oklahoma Republican Congressman Tom Cole helped OU secure the grant, and its National Cancer Institute-designated cancer center is one of two who received it.
American Indian and Alaska Native populations in Oklahoma experience a 36% higher incidence of cancer and a 73% higher death rate from it than the general U.S. population. Rhoades said disparities are caused by numerous factors, including underfunding in the health care systems serving Native Americans and racial misclassifications, which have limited data collection on the population’s health outcomes.
“Whenever we [are] looking for tribal partners or if they come to ask for our help, it's not to be studied to find out, ‘Oh, this is why you're different.’ It's to be studied like, ‘How can you make our population better? We need fixing now,’” Rhoades said.
The first of the ICON grant’s sub-projects will seek to increase lung cancer screening in the Cherokee Nation. The rate of new lung cancer cases in Oklahoma is 63.5 per 100,000, which is higher than the national rate of 54.6. In Oklahoma’s Indigenous communities, that rate is 87.2.
Screenings would occur through the tribal health system with low-dose CT scans, which are a kind of X-ray that provides a detailed picture of patients’ lungs. It can help reduce mortality among high-risk individuals, which are usually current or former smokers over 50.
The cancer center will help health care delivery systems identify people who are eligible for screenings and conduct outreach to help them get in for a test.
Dr. Mark Doescher, associate director for community outreach and engagement at the Stephenson Cancer Center, said the ICON grant will also work to bridge communication gaps between the cancer center and patients’ tribal health primary care providers. An example might be addressing financial challenges, like if a patient doesn’t have gas money to make it to appointments.
“This is a model to try to improve that coordination of care and communication around care. It's truly a collaborative model that, to me, has to happen across a variety of chronic conditions. But, I think doing this within the context of cancer is really important because again, that's the one where I think communications are often most challenged,” Doescher said.
Research will also explore how to be more culturally considerate in care.
“There's very different cultural traditions, and there's also cultural traditions in terms of cultural medicine, traditional healing,” Rhoades said. “Is this something that we should be trying to [incorporate] more from our health systems?”
Arsenic and uranium exposures have historically been higher in Native communities compared to the rest of the U.S. The final sub-project will assess these levels in drinking water from the Northern Plains, the Southern Plains and Arizona and work to develop interventions.
“We're going to see the cancer associations that might be in the water with the heavy metals. … Some tribes can set their own environmental standards. And, if they feel that their water levels need to be changed, is there policies that they might enact?” Rhoades said.
Doescher and Rhoades said they look forward to working on these projects.
“I think this is a very important effort,” Doescher said. “I see it growing in scope in Oklahoma, probably nationally as well.”
