Andrea (Andi) Dwyer, program director for the Colorado Cancer Screening Program (CCSP) at the University of Colorado Cancer Center, is among the authors of a new book that looks at how cancer impacts the descendants of the original inhabitants of many lands, including Native Americans.
Indigenous and Tribal Peoples and Cancer is the work of 223 writers from around the world – cancer researchers, health practitioners, policy makers, and individuals with lived experience of cancer – who contributed 77 chapters.
Among many topics, the book offers snapshots of cancer among native groups in various countries, explores how cancer-control agencies partner with Indigenous groups, describes circles of support for cancer survivors, and examines ways to recruit Indigenous people into research programs. Almost all the chapters include one or more Indigenous co-authors.
The varied peoples encompassed by the book include Native Hawaiians, the First Nations of Canada, Aboriginal groups of Australia, the hundreds of Tribal communities of India, the Māori of New Zealand, and the Diné of the American Southwest.
Dwyer is chair of the American Cancer Society’s National Navigation Roundtable, which focuses on cancer patient navigation, and serves on various related boards.
Dwyer’s chapter focuses on the use of information technology (IT) to support patient cancer care, but notes that smaller care programs serving Indigenous peoples often are being left behind on IT. As one potential solution, the chapter presents a case study of NACI Care, an iPad app for patient navigation data entry, evaluation, and tracking that evolved from a program developed by Native American Cancer Initiatives, Inc. (NACI), a Colorado-based nonprofit.
Dwyer’s co-authors are Linda Burhansstipanov, MSPH, DrPH, a Colorado-based public health researcher, president of NACI, and member of the Cherokee Nation; and Linda Fleisher, PhD, MPH, of the Fox Chase Cancer Center in Philadelphia.
Dwyer says she got involved in the project through partnerships she’s made in her CCSP work with tribal agencies and other community groups in the realm of patient navigation and cancer screening. Over the past 15 years, she’s worked often with Burhansstipanov, who Dwyer refers to as Linda B.
“I’ve worked on different initiatives, particularly involving Native access to care, and Linda B. invited me to be an author on this book with her based on our experience,” Dwyer says. She advised NACI on development of the NACI Care app “because of my experience in working on cancer screening and navigation.”
Dwyer says her main point in writing her chapter “is that we’re not going back to pen and paper in health care. The trajectory is toward technology, and if we don’t get people moving in that direction, they’ll be left behind.”
Access to electronic medical record systems, such as the Epic system used in many hospitals, is sometimes out of reach to rural communities and tribes in terms of cost and logistics, Dwyer says. “I’ve tried to advocate that when we have discussions about ways to expand access, we need to make sure that tribal agencies are included in those discussions. And part of that work is having practical approaches to technology available in real time in the field that’s not dependent on being at a desktop or in a clinic.”
Dwyer also sees big gaps in the availability of cancer screening and other care services in Native American communities, particularly those in rural areas. She says the Indian Health Service (IHS), the federal agency providing care to tribal members, “has limited funding, and some of its health priorities are tailored to specific tribes and specific issues. You might think that IHS takes care of screening, but that’s not always true. And for care, there are coverage issues for tribes as much as for the general population – even more so.”
Dwyer says it was exciting to contribute to the book and to be part of the worldwide initiative to create it. “It was fun to be part of a conversation about indigenous people all over the world and learn that there are more things that connect us than separate us,” she says.
Photo at top: Andrea (Andi) Dwyer (second from left) poses with Arati Prabhakar, PhD, director of the White House Office of Science and Technology Policy, during Prabhakar's visit to the CU Anschutz Medical Campus for a cancer briefing on July 17, 2024. Also pictured: Sabrina Spencer, PhD (left), a CU Cancer Center member and a CU Boulder biochemistry professor; and Sarah Reynolds, RN, a nurse navigator in GI oncology at UCHealth. Photo by Justin LeVett for the CU School of Medicine.