An April report from the Journal of the National Cancer Institute found Native Hawaiians and Pacific Islanders between the ages of 20 and 49 experienced the highest rates of cancer death among that age group in the United States between 2018 and 2020.
To address the rates, the University of Hawaii Cancer Center is working on interventions and an Early Phase Clinical Trial Center to detect and prevent cancer among Native Hawaiians.
“There’s a lot of contributing factors, what we call social determinants of health, that play into some of the poor health among Native Hawaiians,” said Dr. Kevin Cassel of the UH Cancer Center. “We want to start with preventative services, then do more studies to promote screenings, so people can get their cancers detected earlier when it’s most treatable.”
One intervention project that launched in 2005 is Ku Ola, or “upright living,” which focuses on meeting the health care needs of Native Hawaiian men.
“We just came back from an intervention on the Big Island in February,” Cassel said, adding the group will return to Hilo next month. “As a vehicle to build health promotion early on, we’re working with Native Hawaiian men for culturally grounded ways to support dialogue and discussion among men, and make sure they interact with their doctors.”
Those interested in participating can visit: kuola.org.
Topics of the intervention include colon cancer, lung cancer and access to early tests and screenings.
“On the Big Island, it’s very difficult to get from far away places to the hospital or places for screenings,” Cassel said. “So, we want to build capacity for transportation to health care. We’re looking at some of the barriers of care for Native Hawaiian men, and making sure that health care gets embedded as a strong, cultural practice.”
Part of the rise in cancer deaths may be attributed to a change in classification.
Until 1997, race reporting at the federal level grouped together Americans of Asian, Native Hawaiian and Pacific Islander ancestry into a single category.
After the classification change, death certificates are starting to reflect the separate groups, with the report concluding that cancer death rates have only accurately reflected Native Hawaiians since 2018.
“These disparities clearly demonstrate the importance of disaggregation of Asians and NHPIs from one another,” said UH Cancer Center researcher Brenda Hernandez in a press release. “In Hawaii, Asian, Native Hawaiian and Pacific Islander ethnic communities have experienced dramatically different cancer burdens.”
One difference is the rate of breast and lung cancer among Native Hawaiian women.
A UH Cancer Center report from 2018 found Native Hawaiian women had higher death rates from breast and lung cancer than Chinese, Filipino, Japanese and other ethnic groups in Hawaii.
“We want to examine these disparities when we see them,” Cassel said. “With lung cancer, one of the aspects we’re hoping to get started with are spiral (CT) scans or lung cancer screenings, particularly among people who have previously smoked or continue to smoke, and find these cancers early to treat them before they can spread.”
Cassel also noted liver cancer is a rising concern among Native Hawaiians.
“Our liver cancers are particularly high here, and it could be due to those environmental factors, some lifestyle issues, or it could be just higher risk from our populations that are migrating from elsewhere, where risk factors for liver disease are prevalent,” he said. “With our outreach program, we’re looking at hitting communities that are experiencing these disparities and working with them to see what we can do to mitigate these factors.”
Early tests and screenings will be a key part of the new Early Phase Clinical Research Center on Oahu, a project being led by UH Cancer Center Director Naoto Ueno.
The center is designed to provide access to clinical trials for cancer patients in Hawaii so they can avoid traveling to the mainland for treatments.
“We are trying to establish more robust clinical research so that we can provide more clinical trials that would allow people to stay in state,” Ueno said in a press release. “We need to make a collective impact with the various stakeholders, and the UH Cancer Center could be the driving force to make these changes.”
The $13 million Early Phase Clinical Research Center will serve between 100 to 200 patients annually and will incorporate cultural and natural aspects into treatment and prevention.
“What that means is, we can leverage some of the unique, natural products here and other sources that we have and start those early stage clinical trials, which can be a beacon of hope for those who may not have other therapeutic options,” Cassel said. “We look forward to opening very soon.”
The facility is expected to be completed in 2024.