☆ 4.7 Article

Guideline-Concordant Cancer Care and Survival Among American Indian/Alaskan Native Patients

CANCER (2014)

Journal

CANCER

Volume 120, Issue 14, Pages 2183-2190

Publisher

WILEY

DOI: 10.1002/cncr.28683

Keywords

American Indian; Alaskan Native; cancer; guidelines; treatment

Funding

National Cancer Institute [1P50CA148110]
California Department of Public Health
National Cancer Institute's Surveillance, Epidemiology and End Results Program [N01-PC-35,136, N01-PC-35,139, N02-PC-15,105]
Centers for Disease Control and Prevention's National Program of Cancer Registries [U55/CCR921930-02]

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Abstract

BACKGROUND: American Indians/Alaskan Natives (AI/ANs) have the worst 5-year cancer survival of all racial/ethnic groups in the United States. Causes for this disparity are unknown. The authors of this report examined the receipt of cancer treatment among AI/AN patients compared with white patients. METHODS: This was a retrospective cohort study of 338,204 patients who were diagnosed at age >= 65 years with breast, colon, lung, or prostate cancer between 1996 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare database. Nationally accepted guidelines for surgical and adjuvant therapy and surveillance were selected as metrics of optimal, guideline-concordant care. Treatment analyses compared AI/ANs with matched whites. RESULTS: Across cancer types, AI/ANs were less likely to receive optimal cancer treatment and were less likely to undergo surgery (P <=.025 for all cancers). Adjuvant therapy rates were significantly lower for AI/AN patients with breast cancer (P<.001) and colon cancer (P=.001). Rates of post-treatment surveillance also were lower among AI/ANs and were statistically significantly lower for AI/AN patients with breast cancer (P=.002) and prostate cancer (P<.001). Nonreceipt of optimal cancer treatment was associated with significantly worse survival across cancer types. Disease-specific survival for those who did not undergo surgery was significantly lower for patients with breast cancer (hazard ratio [HR], 0.62), colon cancer (HR, 0.74), prostate cancer (HR, 0.52), and lung cancer (HR, 0.36). Survival rates also were significantly lower for those patients who did not receive adjuvant therapy for breast cancer (HR, 0.56), colon cancer (HR, 0.59), or prostate cancer (HR, 0.81; all 95% confidence intervals were <1.0). CONCLUSIONS: Fewer AI/AN patients than white patients received guideline-concordant cancer treatment across the 4 most common cancers. Efforts to explain these differences are critical to improving cancer care and survival for AI/AN patients. (C) 2014 American Cancer Society.

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Suicidal Ideation in American Indian and Alaskan Native College-Attending Students

Elyse J. Thulin, Sarah K. Lipson, Justin E. Heinze, Sasha Zhou

Summary: Despite the high risk of suicide, mental health research on American Indian/Alaskan Native (AIAN) emerging adults is lacking. This study aims to explore the risk and protective factors of suicidality among AIAN-identifying individuals. The results show high rates of suicidal ideation, particularly among gender minority-identifying students. Non-suicidal self-injury, self-perceived need for help, and flourishing are associated with suicidality across all gender identities. It is crucial to emphasize student awareness of mental health services and further investigate protective factors and community support for AIAN college students.

AMERICAN JOURNAL OF PREVENTIVE MEDICINE (2023)