Indigenous Navigation and Partnerships Aim to Reduce Cancer Disparities

Cancer disparities continue to affect Native and Indigenous communities across the United States, with barriers to access, historical underfunding and gaps in culturally informed care contributing to higher mortality rates.

To better understand efforts to close these gaps, CURE sat down for an interview with Rodney Haring, co-director of the Health Communications Shared Resource, a member of the Seneca Nation and chair of the Department of Indigenous Cancer Health at Roswell Park Comprehensive Cancer Center. He discussed how Indigenous patient navigation, nation-to-nation partnerships and culturally grounded prevention strategies are shaping more equitable cancer care for Native communities.

CURE: Can you describe the work you do with indigenous patient navigation at Roswell Park Comprehensive Cancer Center? How does it address disparities in cancer care?

Haring: Roswell Park Comprehensive Cancer Center is the oldest cancer center in the United States. We are situated in the indigenous homelands of the Haudenosaunee, previously known as the Iroquois nations. Each NCI-designated cancer center across the United States has Native Nations within its proximity, so it is vital to learn what those relationships are and how we situate together. This understanding lays the foundation for what patient navigation is for our indigenous and Native communities.

Our navigation program is unique because our patient navigators are from the Native communities in our region. They co-habitate within the federal or tribal Indian Health Service on reservation areas, but they are also co-housed here at Roswell Park. Being housed in both the community and on campus allows our navigators to provide essential support to community members as they navigate the journey across the cancer care continuum, from patient care and treatment to survivorship and palliative care.

I would also like to mention that Roswell Park is home to the Department of Indigenous Cancer Health. Among federal NCI-designated cancer centers, we are the only one with a full department dedicated to indigenous cancer health. We have been working with other federal cancer centers to engage in conversations and start centers for indigenous research, healthcare services and education. We have existed as a department since 2019, and prior to that, we operated as a center for indigenous cancer research and services.

A recent American Cancer Society report highlighted some statistics about Native Americans and how that community faces the highest cancer mortality in the U.S. Why do these disparities persist, and what are some of the biggest barriers to care, from your perspective?

I think the primary challenge has been relationships. It is important to understand that Native Americans are not only a racial and ethnic group but also a political classification as sovereign nations. As such, the conversation ties into treaty negotiations for healthcare between sovereign Native American nations and federal cancer centers, as well as the federal responsibility for healthcare. When considering why cancer rates and disparities are so high, it is necessary to look at what the government has provided for cancer care within Native Nations.

Historically, at many points, more money has been allocated for the healthcare of a person in federal prison than for a Native American through Indian Health Services. You would actually receive better healthcare in prison than through Indian Health Services at many points in history. While money does not solve everything, the relationship between cancer centers, Indian Health Services and those working in Indian Country can shape and improve outcomes. Building these relationships, as our department does, improves early detection, screening, and the confidence between indigenous communities and federal institutions.

Community outreach specifically designated for federally recognized tribes is essential. When you create avenues to understand how these systems work together, you begin to improve cancer health outcomes. As more cancer centers prioritize these relationships, we will see more drastic changes in outcomes.

How do cultural practices and traditions influence the approach you take in supporting Native American patients through their cancer journey?

It is vital to work with tribal nations, their healers and Indian Health Services to understand cultural nuances that can improve care across treatment, survivorship and prevention. We must look at this in more than just a cancer context; we must consider co-occurring conditions, such as obesity-related cancers and diabetes, which have a significant influence on our communities. Understanding how these unique nuances affect holistic health is important for universities and cancer centers alike.

When we bridge indigenous knowledge of ancestral medicines, traditional physical activity and holistic well-being, we see improved outcomes. These traditions are a part of who we are and incorporating indigenous ways of knowing into healthcare is an important factor that differs from the Western science perspective.

What strategies or policies do you believe are most important to reduce the cancer mortality gap that currently exists among Native American populations?

One strategy is building relationships with communities based on a nation-to-nation and healthcare-provider standpoint. Our patient navigation models are based on working within rural landscapes while respecting tribal nations. We have navigators situated in both rural communities and on reservations who work hand-in-hand. They respect traditional healthcare and Indian Health Services while understanding how these interplay with rural healthcare and federal cancer centers.

Clinical trials are also vital. From a research perspective, some cancer medicines may not be as effective for Native people because they were normed for non-Native populations. We must educate tribal leaders and communities about clinical trials, including the ethics, data user agreements and protections involved from a tribal government standpoint. Respecting the sovereignty of the tribal government and the tribal citizen is essential. If we are not included in clinical trials, we may receive medicine that is ineffective or even harmful for our population. We need to be part of that process while ensuring the sovereignty of Native Nations is respected.

How can the broader healthcare system better support indigenous communities in both prevention and treatment of cancer?

I go back to the importance of being present and included in conversations. I challenge healthcare centers that do not have a strategic plan for working with Native Nations to include them in the conversation. We should work together across all aspects of healthcare, including community health educators and education departments. These departments are important for training the next generation of cancer health providers.

Outreach and engagement are necessary so that we can collectively understand the healthcare needs of the people in our regions.

Looking ahead, what is your ultimate vision for the future of cancer care in Native communities, and is there anything else you’d like to leave our audience with today?

We have talked a lot about patient navigation, which is a growing sector with navigators at both cancer centers and tribal health clinics. Beyond that, I think we should embrace more conversations around cancer prevention. While the word "cancer" often brings up thoughts of treatment, starting early with prevention can change things for the next generation.

Much of our work involves looking many generations ahead. The pathways we lay down now as clinicians and the relationships we build should be for the benefit of generations to come, not just for the here and now.

Transcript has been edited for clarity and conciseness.

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