Urban vs. Rural Areas: Differences in Barriers to Cancer Symptom Management among American Indians in the Southwest

American Indians and Alaska Natives experience the poorest survival from all cancers combined than any other racial group. Contributing factors include late or inadequate access to treatment, lack of access to culturally sensitive education, language barriers, poverty, unreliable or nonexistent transportation, and cultural beliefs surrounding cancer, all of which are regionally influenced. This presentation describes the results of the first phase of a large randomized clinical trial designed to reduce/overcome barriers to cancer-related symptom management among American Indians residing in the Southwest. A series of focus groups (N=130) among cancer patients, survivors, and their family members were conducted in 2008-2009. Discussions explored culturally specific barriers (knowledge, communication, illness beliefs) and facilitators (social support, spirituality) to appropriate symptom management and cancer treatment. Both urban and rural sites reported the greatest barriers as lack of communication, transportation and access to care. Findings indicated that barriers faced by rural sites include lengthy travel to obtain care, language differences, illness beliefs, a general lack of support, resources and technology, and traditional healing preferences. In contrast, urban groups noted difficulty in accessing care, late or misdiagnosed cancer, inadequate treatment, lack of knowledge, and reliance on public transportation to obtain care as significant barriers. It is important to identify and understand these culturally and geographically-influenced barriers to cancer treatment and symptom management in order to create programs to eliminate health disparities for American Indians that are appropriate to their region of residence.