Disparities in pancreatic cancer care and research in Native Americans: Righting a history of wrongs

Abstract

Disparities in pancreatic cancer incidence and outcomes exist in Native American populations. These disparities are multifactorial, difficult to quantify, and are influenced by historical, socioeconomic, and health care structural factors. The objective of this article was to assess these factors and offer a call to action to overcome them. The authors reviewed published data on pancreatic cancer in Native American populations with a focus on disparities in incidence, outcomes, and research efforts. The historical context of the interactions between Native Americans and the United States health care system was also analyzed to form actionable items to build trust and collaboration. The incidence of pancreatic cancer in Native Americans is higher than that in the general US population and has the worst survival of any major racial or ethnic group. These outcomes are influenced by a patient population with often poor access to high‐quality cancer care, historical trauma potentially leading to reduced care utilization, and a lack of research focused on etiologies and comorbid conditions that contribute to these disparities. A collaborative effort between nontribal and tribal leaders and cancer centers is key to addressing disparities in pancreatic cancer outcomes and research. More population‐level studies are needed to better understand the incidence, etiologies, and comorbid conditions of pancreatic cancer in Native Americans. Finally, a concerted, focused effort should be undertaken between nontribal and tribal entities to increase the access of Native Americans to high‐quality care for pancreatic cancer and other lethal malignancies.

Global trends in the incidence and mortality of pancreatic cancer based on geographic location, socioeconomic status, and demographic shift

“…This finding may be attributed to several factors such as, disproportionately greater health seeking behavior and medical consultations among women, 15 and a relatively greater proportion of indigenous native American population with a slightly higher female predominance 16 . Native American ethnicity is shown to be a risk factor for PC, with associated worse survival in epidemiological studies 17 . In some countries such as Japan, Russia, Italy, and France, the higher female PC burden could partially be explained by lower male‐to‐female ratio in these countries and higher female life expectancy 18…”

“…16 Native American ethnicity is shown to be a risk factor for PC, with associated worse survival in epidemiological studies. 17 In some countries such as Japan, Russia, Italy, and France, the higher female PC burden could partially be explained by lower male-to-female ratio in these countries and higher female life expectancy. 18 We noted an association between PC and socioeconomic status with increasing burden noted in higher HDI countries.…”

The Moby Bookmobile: Providing Health Education Materials in Wyoming Indian Country

“…One specific issue the Moby Bookmobile was designed to address was the inability for the community to access tribal public and school libraries, creating an opportunity to provide reading materials to the populations served on the Wind River Indian Reservation. Adding culturally relevant health-related books and materials to the bookmobile collection was an attempt to address the well-documented issue of rural Native American populations having a number of health-related disparities and issues (Findling et al, 2022; Kills First et al, 2022; Palmer et al, 2022; Zahnd et al, 2022). For this reason, the Moby Bookmobile sought and received funding from the NNLM Region 4, to increase access to health education books and other health-related materials to be distributed to the Wind River Reservation Communities.…”