Oklahoma Researchers Enhance Cancer Care for Indigenous Patients

A recent initiative by researchers at the University of Oklahoma aims to address significant cancer care disparities faced by Indigenous Oklahomans. Through a novel care coordination and communication program, the pilot project successfully reduced missed appointments from 19% to 11%, while providing financial assistance for travel needs to two-thirds of participating patients.

The Indian Health Service (IHS), part of the U.S. Department of Health and Human Services, oversees health services for American Indians and Alaska Natives. Indigenous patients in Oklahoma primarily access care through the ITU system, which encompasses federally administered IHS facilities, tribally administered facilities, and urban Indian facilities. Unfortunately, this system suffers from chronic underfunding, limiting access to specialty services such as cancer care.

When specialty services are unavailable, patients often require referrals through the IHS Purchased/Referred Care program. This program operates on limited congressional funding and aims to fill service gaps by covering costs for outside providers. However, the referral process can be fraught with challenges, including prior authorization requirements that can delay time-sensitive care. Uninsured patients face additional hurdles, as do those navigating fragmented communication between the referral system and oncology clinicians.

To mitigate these challenges, the OU Health Stephenson Cancer Center has operated an American Indian Navigation Program since 2012, assisting 4,463 Indigenous patients from 65 different tribes. This initiative aims to help patients overcome logistical and cultural barriers as they transition between the ITU and the Stephenson Cancer Center systems. The team identifies eligible patients through referrals and collaborates with facilities to ensure necessary authorizations for cancer treatment, lab work, and diagnostic imaging tests.

Amanda Janitz, an associate professor of epidemiology at the OU Hudson College of Public Health and a member of the Choctaw Nation, played a key role in enhancing these services. Funded by the American Cancer Society, a recent pilot program provided improved navigation services to better address issues affecting access to cancer care.

“There were a lot of frustrations and communication challenges here at the cancer center, also at the tribal health facilities,” Janitz stated. “So we decided to continue moving this work forward.”

The pilot program served 128 patients from July 2023 to February 2025, offering dedicated support from a nurse navigator. This included screenings for financial hardships, psychosocial needs, and distress levels, as well as education on clinical trials. The research team observed a significant increase in depression screenings, rising from 72% to 100%.

Janitz highlighted the logistical challenges faced by patients traveling several hours for treatment, emphasizing that these barriers can significantly impact their health outcomes. The pilot program also introduced regular virtual meetings between navigators and tribal case managers to address additional issues faced by patients. Feedback indicated that these communications were both helpful and practical.

Looking ahead, Janitz and her colleagues plan to expand their efforts through the Care Coordination and Communication Program in Oncology for Tribal Health Systems. This initiative will be supported by a $17.2 million grant from the National Institutes of Health received last year, which focuses on cancer prevention, screening, and care coordination activities.

The upcoming project will introduce virtual “huddles” between teams from the Stephenson Cancer Center and referring facilities. These meetings will allow clinicians to discuss treatment plans while navigators and case managers address psychosocial needs and referral obstacles. Janitz indicated that this approach will also be integrated into a clinical trial set to begin next year, where participants will be randomized to receive either huddles or standard navigation services.

“What I really like about these types of research projects is that we can see improvements for patients very quickly,” Janitz remarked. “We’re working directly with patients who are undergoing cancer treatment, and we are providing them with some resources in terms of this enhanced navigation that we expect to be beneficial.”

Through these innovative approaches, the University of Oklahoma’s research team aims to create lasting positive impacts on the health and well-being of Indigenous Oklahomans facing cancer care disparities.