Understanding Native American/Alaska Native Attitudes Toward Radiation Therapy

Abstract

Native American/Alaska Natives (NA/AI) present with cancer at more advanced stages and have the worst five year cancer specific survival of all racial groups in the United States. Preliminary research has shown that a significant number of NA/AI do not complete guideline concordant cancer care. Our aim is to better understand NA/AI attitudes towards radiation therapy (RT) with a particular focus on logistical concerns. NA/AI cancer patients at the Phoenix Indian Medical Center (PIMC) that received previous RT or were recommended to receive RT were eligible for the survey study. An 18 item written questionnaire developed by the investigators was administered to each consented participant at the PIMC. A total of 50 surveys were administered between the dates of October 1, 2018 through February 15, 2018. Univariable analyses were performed using analysis of variance and group paired t tests to examine statistical associations between patient listed barriers and/or concerns and patient specific variables. Fifty adult NA/AI patients were recruited onto this IRB approved survey protocol. Enrolled patients characteristics included age less than 60 years old (54%), women (84%) diagnosed with breast cancer (62%), 40% of patients were currently employed, and majority of patients (90%) received their RT within 50 miles of home. Patients responded with the answer “Usually or Always” 80% and 82% of the time in relation to how easy to understand was the RT team and how often did the RT team listen to you, respectively. Twenty percent of patients found the length of RT to be of significant importance. Ten percent of patients were willing to travel more than 50 miles if RT could be delivered over a shorter course. The top ranked barriers to RT are Cost of Treatment, Transportation, and Insurance Compatibility. The top ranked concerns about RT are Side Effects and Cost of Treatment. On univariable analysis of barriers, there are associations between being employed and accessibility of medical facilities (p=0.004) and age > 65 years and insurance compatibility (p=0.04). On univariable analysis of concerns, there are associations between being employed and cultural beliefs (p=0.04) and being employed and transportation (p=0.05). Patients willing to travel more than 50 miles for shorter course RT are currently employed (p=0.03), concerned about insurance (p=0.04), and are male (p=0.002) NA/AI patients are concerned about the side effects of RT and logistics of treatment particularly costs, transportation and insurance compatibility continue to be barriers. Culturally specific education and hypofractionation of RT are strategies that could increase acceptance of RT in the cancer care of NA/AI.