Huntsman Cancer Institute has received a $3.9 million grant to improve detection and treatment of cancers among American Indians who live in rural and "frontier" parts of Utah and Montana.

The 51-month demonstration project is funded by the Centers for Medicare and Medicaid Services, which also awarded grants to five other demonstration sites to reach different underserved ethnic populations.

"This is important because Native Americans are the most underserved population medically in our country by far, and particularly with cancer," said Dr. Randall Burt, institute interim director and principal investigator for the Utah-Montana project. "It's often a death sentence."

Geographical remoteness adds a huge barrier to getting care for cancer, he said. It's hard enough in rural areas, but frontier areas, defined as having six or fewer people per square mile, are even more difficult.

Researchers hope the demonstration will answer: "How do we help people who have basically lacked access, based on partly geographical issues, navigate through the system?" said Dr. Randall Rupper, an investigator for HCI and the VA Salt Lake Geriatric Research Education and Clinical Center and co-principal investigator.

The project will focus on seeing that Medicare-qualified American Indians in the rural and frontier communities receive appropriate screening for breast, cervical, colorectal and prostate cancer, according to Rupper. He said that those diagnosed with cancer will be helped to overcome any barriers to treatment, including language, transportation and other issues.

"Navigators" are at the center of the project — outreach workers hired from the target population itself who will be trained as "community advocates and champions" to guide people through the complexities of screening and then accessing any treatment that's needed, Rupper said. One of the tasks is finding appropriate care as close to where the individual lives as possible.

Although it's believed that American Indians may have higher risk of certain cancers, "we don't know the full scope of cancer rates because screening rates are so low. Access is limited," Rupper said.

Clearly, lung cancer is a "big issue" among Native Americans. Prostate cancer and breast cancer rates may be elevated, as well. Taking the project to the rural areas is likely to provide "a better feel for what's happening on the street," Rupper said.

Because Medicare has strict rules about what it pays for services and which services it covers, this type of demonstration project is one of the few ways the huge federal program can "experiment with novel methods of delivering care," Rupper said.

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Together, the six demonstration sites will enroll 13,000 members of minority populations. HCI hopes to enroll 1,800 American Indians, including those enrolled by Sletten Cancer Institute at Benefits Healthcare in Great Falls, which has subcontracted to recruit enrollees in Montana for the demonstration project.

"I think this is, hopefully, part of a larger vision of getting individuals the care they need," Rupper said.

The project runs just over four years, and near the end, the projects will all be evaluated by the federal program, which could adopt some of what is learned to improve access.

The other demonstration sites are Molokai General Hospital in Hawaii (Pacific Islander and Asian American patients), University of Texas (Hispanic-Mexican American), New Jersey Medical School (Hispanic-Puerto Rican), Johns Hopkins University in Maryland (African American) and Josephine Ford Cancer Center in Michigan (African American).