CDRP Update Rapid CityUniversity Wisconsin

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CDRP UpdateRapid City/University Wisconsin
RTOG June 2006 Philadelphia, PA

• Minesh Mehta, MD
• Daniel G. Petereit, MD
• University of Wisconsin Medical School

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Rapid City/UW Update

• Patient Navigation
• Surveys
• Community survey
• Cancer survey
• Clinical trials
• Cooperative Group Trials
• CDRP brachytherapy, tomotherapy
• ATM
• Analysis of program

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Patient Navigation (PN)

• Protocol open June 2004 (official start date
  grant)
• Provide support and some financial assistance
• 149 AIs undergone PN
• Overall median number of contacts 5 (0-85)
• Radiation patients 19 (0-59)
• Patient Navigator database to be analyzed
• Shannon Sparks, PhD
• University of Wisconsin

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Surveys

• A Community Survey to Identify and Document the
  Barriers to Timely and Effective Cancer
  Screening, Diagnosis and Treatment for the Native
  American Community
• Opened in June 2004 604 of 1,000 completed
• Cancer patient survey investigate whether there
  is a correlation between attitudes and beliefs
  towards cancer AND stage at presentation
• 99 of 200 completed
• Partial analysis underway
• Consultant Ashleigh Guadagnolo, MD
• JCRT resident, now at MDAH

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Community Survey Preliminary Results

• Based on 289 surveys presented ASTRO 2005
• Goal identify potential barriers early cancer
  RX detection
• Hypothesis Cancer screening rates for prostate,
  breast cervical cancer positively correlate
• increased level of education
• greater knowledge about cancer
• positive perception regarding the chances of
  surviving cancer
• younger age
• Material and methods
• CRR administered 1 hour interview

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Community Survey Preliminary Results

• Preliminary results indicate about half of adult
  Native Americans underwent cancer screening at
  least once
• Factors associated with cancer screening were
  greater knowledge about cancer and being female
• Results suggest an educational program on cancer
  and the importance of early detection and
  treatment could be effective in reducing cancer
  disparities for AIs
• Current analysis underway 600 surveys
• Rebecca Koscik, PhD
• University of Wisconsin

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Phase II Trial HDR Brachytherapy Stage I and II
Breast Cancer

• Similar criteria as previous APBI RTOG trial
• 34 Gy/10 Fxs
• Endpoints
• Evaluate the rate acute, late toxicities
• Efficacy, local control, cosmesis
• 15 pts enrolled out of 100 (3 AIs)
• Majority interstitial technique
• 1 G3 toxicity recurrent infection requiring
  drainage
• Mammosite technique
• 15 patients enrolled to date mainly
  interstitial technique

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Phase II Study High Dose Rate Brachytherapy
Advanced Prostate Cancer

• Patient eligibility intermediate, high-risk
  prostate cancer
• Androgen ablation 6 to 12 months
• EBRT 2.2 Gy X 16 over 15 treatment days, HDR
  6.5 Gy X 3
• Endpoints
• Evaluate the rate acute, late toxicities
• Efficacy HDR boost
• 4 patients enrolled (0 AIs) out of 100
• No G3 toxicities
• Low accrual because of tomotherapy trial
• Considering changing HDR FX from 6.5 x 3, to 9 Gy
  x 2 to increase accrual by eliminating need for
  hospitalization

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TOMOTHERAPY PROSTATE TRIAL
Phase I/II Hypofractionation Trial
Multi-institutional Phase I/II trial (PI Mark
Ritter, MD, PhD) -Level I/II completed (2006
ASTRO abstract) -160 patients No G3 toxicities
Rapid City 26 patients enrolled (2 AIs)
minimal toxicities, no G3 -Most rapidly accruing
trial every opened Level I nearly completed in
Rapid City
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ATM MUTATIONS in Native Americans Possible
Association with Cancer and Radiotherapy
Toxicities

• To determine the association between ATM
  heterozygosity and sensitivity to radiation
• 35 patients, 10 American Indians
• Gene sequencing underway
• Amy Moser, PhD

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Cooperative Group Trials, Total Number

• RTOG, NCCTG, ECOG, NSABP, others
• 2004-05
• 41 total
• 5 AIs (4 treatment, 1 cancer prevention)
• 2005-06
• 52 total
• 1 AI
• Total number of American Indians entered on
  trials since program opened June 2004
• Cancer Survey 20
• General Survey 604
• ATM 10
• CDRP treatment trials 5
• Cooperative Group Trials 6
• TOTAL 645
• Number of AIs on clinical trials nationally 7
• AACR 2006

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TELESYNERGY Redeployment
Rapid City
Pine Ridge Hospital
-The TELESYNERGY system (TS) at the University
Wisconsin was redeployed to Pine Ridge Hospital
May 2006 -Plans underway to rapidly increase TS
use -Ultimate goal increase access to health
careAmerican Indians
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Manuscripts

• Petereit DG, Rogers D, Govern F, et al.
  Increasing access to clinical cancer trials and
  emerging technologies for minority populations
  the Native American Project. J Clin Oncol. 2004
  Nov 1522(22)4452-5
• Rogers D, Petereit DG. Cancer Disparities
  Research Partnership In Lakota Country Clinical
  Trials, Patient Services And Community Education
  For The Oglala, Rosebud And Cheyenne River Sioux
  Tribes. American Journal of Public Health 95
  (12)1-4 2005
• Petereit DG, Rogers D, Burhansstipanov L, et al.
  Walking Forward The South Dakota Native
  American Project. Journal of Cancer Education 20
  (supplement) 65-70 2005
• Petereit DG. Maintaining And Acquiring
  Brachytherapy Skills. Journal of American
  College of Radiology Jun 20 938-402005
• Eastmo E, Petereit DG. Accelerated Partial
  Breast Irradiation Expanding Options for Breast
  Preservation. Advance for Imaging and Oncology,
  November 91-95 2005.

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Abstracts / Book Chapters

• Petereit DG, Rogers D, Helbig P et al. Cancer
  Screening Behavior In A Native American
  Population. Int J Radiat Oncol Biol Phys. 63 (2
  supplement 1) S445, 2005.
• Petereit DG. Methods to Address Cancer
  Disparities for Native Americans in Western,
  South Dakota. Proceeding of the 97th Annual
  Meeting of the American Association for Cancer
  Research (AACR). Abstract FO 01-02, page 1354,
  2006.
• Bradley KA, Petereit DG Radiation Therapy For
  Gynecologic Malignancies. Hematology/Oncology
  Clinics of North America (In Press 2006)
• Viswanathan AN, Petereit D. Gynecologic
  Brachytherapy. In Devlin P, editor.
  Brachytherapy Techniques and Applications.
  Lippincott, Williams and Wilkins, (In Press 2006)
  
• Burhansstipanov, L Petereit, DF Genetics and
  Ethics in Nursing--New Questions in the Age of
  Genomic Health (In press 2006)

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Analysis of Program/Future Plans

• Community Survey
• Analysis of 600 surveys underway
• Rebecca Koscik, PhD
• Post-patient navigation analysis
• Some post PN questions in cancer survey
• New survey nearly complete
• Shannon Sparks, PhD
• Analysis of softer endpoints such as trust
• Shannon Sparks, PhD
• CT colonography project
• PIs Paul Limburg, MD Mayo Clinic, Daniel
  Petereit Rapid City
• Hypothesis is a minimally prepped colon via CT
  colonograpy as sensitive as colonoscopy in the
  detection of polyps gt 7 mm in asymptomatic AIs gt
  50 yrs old
• Grant will be submitted 7/1/06