Timeliness of Breast Cancer Treatment Within The Alaska Tribal Health System.

PURPOSE: This study examined the time from breast cancer diagnosis to initiation of treatment among Alaska Native (AN) women. We evaluated the impact of age, cancer stage, and rural/urban residence at diagnosis. METHODS: We evaluated characteristics of women recorded in the Alaska Native Tumor Registry who received a first diagnosis of breast cancer between 2009 and 2013. Median time from diagnosis to treatment was assessed. Associations of demographic and clinical characteristics with timely initiation of treatment were evaluated using logistic regression and Cox proportional hazards models. RESULTS: Two hundred seventy-eight (278) AN women were diagnosed with invasive breast cancer in years 2009-2013. Mean age at diagnosis was 56.8 years (SD = 13.0). The median time from diagnosis to initiation of treatment was 23 days (P < .05) with most (94.6%, n = 263) meeting the ≤60-day guideline target. Time to treatment was not associated with rural/urban residence, age, or stage at cancer diagnosis. CONCLUSION: These findings indicate that most AN women diagnosed with breast cancer within the AN Tribal Health System receive timely treatment after diagnosis.

Behavioral health aides in rural Alaska: their experience in caring for Alaska Native cancer survivors.

The Alaska Native Tribal Health Consortium conducted a statewide survey of rural community behavioral health aides (BHAs) within the tribal health system to assess their need for psychological and emotional support training for their work with cancer survivors. An electronic survey was distributed to all 114 rural BHAs in Alaska. They were asked about cancer survivors living in their community, whether they had been called to provide counseling to those survivors and about their comfort level in addressing cancer-related emotional issues and concerns experience by the patients and their families. Sixty-one (54 %) BHAs responded, 62 % knew of cancer survivors in their community, and 88 % of whom agreed that it is their job to provide support to those cancer survivors. Of the 47 % of BHAs who had provided counseling to cancer survivors, 63 % noted a lack of adequate training about how to provide that counseling. Dealing with "emotional concerns" was reported as the most difficult issue. Almost all (98 %) reported that they would likely participate in training to improve counseling skills. Most BHAs in rural Alaska know of a cancer survivor in their community and may be called on to provide mental health services, but few report adequate training in how to provide these services. Given the remote locations in which many BHAs work and the lack of local resources to guide them, more education is needed about how to support cancer survivors. This study provides information to help guide development of content of that education.

Focus groups of Alaska Native adolescent tobacco users: preferences for tobacco cessation interventions and barriers to participation.

Tobacco cessation interventions developed for Alaska Native adolescents do not exist. This study employed focus group methodology to explore preferences for tobacco cessation interventions and barriers to participation among 49 Alaska Natives (61% female) with a mean age of 14.6 (SD = 1.6) who resided in western Alaska. Using content analysis, themes from the 12 focus groups were found to be consistent across village, gender, and age groups. Program location or site (e.g., away from the village, hunting, fishing), a group-based format, and inclusion of medication and personal stories were reported to be important attributes of cessation programs. Motivators to quit tobacco were the perceived adverse health effects of tobacco, improved self-image and appearance, and the potential to be a future role model as a non-tobacco user for family and friends. Parents were perceived as potentially supportive to the adolescent in quitting tobacco. The findings will be used to develop tobacco cessation programs for Alaska Native youth.