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Shared and Unshared Barriers to Cancer Symptom Management Among Urban and Rural American Indians


  • Funding: This research was supported by a grant from the National Cancer Institute (NCI), National Institutes of Health (NIH), R01 CA115358.

  • Acknowledgments: We would like to thank the cancer patients, survivors, and family members for sharing their experiences and time; without them, this project would not have been possible. In addition, we would like to thank the clinic sites and tribal communities for permitting us to use their facilities. This manuscript's contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH/NCI or the Indian Health Service.



Before the end of the 20th century, American Indians (AIs) primarily resided in nonmetropolitan areas. Shifting demographic trends have led to a majority of AIs now living in urban areas, leading to new health care barriers for AIs. AIs experience the poorest survival from all cancers combined compared to all other racial groups. Identifying and classifying barriers to cancer care may facilitate supportive interventions and programs to improve access and treatment.


A 5-year cancer symptom management project targeted AIs in the Southwest. The first phase of the randomized clinical trial consisted of 13 focus groups (N = 126) of cancer patients/survivors and their caregivers. Discussions explored existing and perceived barriers and facilitators to cancer symptom management and cancer treatment.


Significant barriers to cancer-related care were found among urban AIs, as compared to their rural counterparts. Barriers were classified within 4 subgroups: (1) structural, (2) physical, (3) supportive, or (4) cultural. Urban AIs reported barriers that are both structural and physical (inadequate access to care and public transportation) and supportive (lack of support, resources and technology, and less access to traditional healing). Rural participants reported communication and culture barriers (language differences, illness beliefs, and low levels of cancer care knowledge), as well as unique structural, physical, and supportive barriers.


It is important to identify and understand culturally and geographically influenced barriers to cancer treatment and symptom management. We provide recommendations for strategies to reduce health disparities for AIs that are appropriate to their region of residence and barrier type.