Cancer Screening and Care for AIANs in Washington State Scott Ramsey Fred Hutchinson Cancer Research Center

Cancer care disparities Case studies suggest for AIANs: Case studies suggest for AIANs: Less access to screening services (mammography, colonoscopy) Less access to screening services (mammography, colonoscopy) Diagnosed at later cancer stages (harder to treat) Diagnosed at later cancer stages (harder to treat) May drop out of cancer care before it’s completed May drop out of cancer care before it’s completed We don’t have hard data looking at patterns of cancer care to show the disparities We don’t have hard data looking at patterns of cancer care to show the disparities We need to call attention to the details of the disparities to get funding to reduce them We need to call attention to the details of the disparities to get funding to reduce them

Documenting the problem First step: First step: Examine Washington State Cancer Registry records Examine Washington State Cancer Registry records AIAN vs. non-AIAN AIAN vs. non-AIAN Medicaid vs. non-Medicaid Medicaid vs. non-Medicaid

Ongoing project: Cancer Care for AIAN Access Access Did the patient get the right treatment? Did the patient get the right treatment? Did it happen at the right time? Did it happen at the right time? Was treatment of sufficient duration? Was treatment of sufficient duration? Outcomes Outcomes How does survival for AIANs compare to non- How does survival for AIANs compare to non- AIANs with the same cancer (and cancer stage at diagnosis)? AIANs with the same cancer (and cancer stage at diagnosis)?

How will we get the data? Partnership with Northwest Portland Area Indian Health Board Partnership with Northwest Portland Area Indian Health Board NW Tribal Registry Project NW Tribal Registry Project Combine data from three sources: Combine data from three sources: Northwest Tribal Registry Northwest Tribal Registry The WA State Cancer Registry The WA State Cancer Registry The WA State Medicaid claims database The WA State Medicaid claims database

Objective of the linkage A dataset of all cancer care services for AIAN patients paid for by Washington State Medicaid A dataset of all cancer care services for AIAN patients paid for by Washington State Medicaid Can analyze patterns of cancer care for AIANs (in WA) and compare to the non-AIAN Medicaid cancer patients Can analyze patterns of cancer care for AIANs (in WA) and compare to the non-AIAN Medicaid cancer patients

Confidentiality maintained Names used only to link up the data Names used only to link up the data After the link, names are removed After the link, names are removed No other identifying information either No other identifying information either Analyses will look at Native patients in WA as a group Analyses will look at Native patients in WA as a group No comparing of tribes No comparing of tribes

Early Results

Cancer cases with Washington State Cancer Registry (WSCR) and NPAIHB (IHS + tribal) enrollment, by Medicaid enrollment, Medicaid-EnrolledNot in Medicaid FrequencyPercentFrequencyPercent AIAN Other races5, , % of AIAN with cancer enrolled in Medicaid at or following diagnosis 12% of non-AIAN enrolled at or following diagnosis

Cancers by stage among AIAN persons identified in WSCR + NPAIHB + Medicaid enrollment Site Summary Stage Total In situLocalizedRegionalDistantUnknown Breast Colorectal Lung Prostate Ovary

Time from diagnosis to surgery (months) Washington State, █ Breast - Local/Regional █ Lung - Local/Regional █ Colorectal - Local/Regional

Proportions receiving surgical resection for localized disease, by cancer, Non-MedicaidMedicaid Cancer Type Non-AIANAIANNon-AIANAIAN Breast 91%94%91%95% Lung 85%100%73%45% Colorectal 97%100%97%100% All Cancers 91%96%88%86%

Planned analyses % of patients receiving appropriate treatment % of patients receiving appropriate treatment How distance to provider affects quality of cancer care How distance to provider affects quality of cancer care Survival (when possible) Survival (when possible)

Future directions Look at cancer care for AIANs who aren’t enrolled in Medicaid Look at cancer care for AIANs who aren’t enrolled in Medicaid IHS contract health service providers IHS contract health service providers Look at use of cancer screening for AIANs Look at use of cancer screening for AIANs New NCI-funded project starting Summer 2007 New NCI-funded project starting Summer 2007 Expand analysis to Oregon and California Expand analysis to Oregon and California Includes interviews of Native cancer survivors, to be conducted by NPAIHB Includes interviews of Native cancer survivors, to be conducted by NPAIHB

Timeline Winter 2006 Winter 2006 Screening analysis project was approved by resolution by the NPAIHB delegates Screening analysis project was approved by resolution by the NPAIHB delegates Spring 2007 Spring 2007 Acquiring updated cancer diagnosis information (including 2004 diagnoses) and Medicaid data for Washington State Acquiring updated cancer diagnosis information (including 2004 diagnoses) and Medicaid data for Washington State Summer 2007 Summer 2007 Completing IRB and data use applications to acquire data from Idaho and Oregon cancer registries for linkage with RPMS data Completing IRB and data use applications to acquire data from Idaho and Oregon cancer registries for linkage with RPMS data

Questions? Concerns?