University of Oklahoma Health Campus researchers found that a novel care coordination and communication program has the potential to support Indigenous Oklahomans – who face significant cancer disparities – in accessing cancer care.
Indian Health Service (IHS), an agency within the U.S. Department of Health and Human Services, is responsible for providing health services to American Indians and Alaska Natives.
Indigenous Oklahomans access this care from the ITU system, which includes federally administered IHS facilities, tribally administered facilities and urban Indian facilities.
But that system is limited by chronic underfunding. So, when specialty services like cancer care aren’t available, patients require referrals through the IHS Purchased/Referred Care program, which operates on limited funds appropriated by Congress and aims to fill gaps by paying outside providers for services. Referrals must be authorized for payment and are not always approved.
The process of coordinating cancer care referrals can be difficult, amid challenges like prior authorization requirements delaying time-sensitive care, uninsured patients facing additional barriers to being approved and fragmented communication between the referral system and oncology clinicians.
Patient navigation assistance is meant to help overcome these challenges. The OU Health Stephenson Cancer Center has operated with an American Indian Navigation Program since 2012, serving 4,463 Indigenous patients from 65 different tribes. It was established to help Indigenous patients navigate logistical and cultural barriers when transitioning between the ITU and Stephenson Cancer Center systems.
The team identifies eligible patients through referrals and collaborates with the other facilities to ensure authorization for cancer treatment, lab work and diagnostic imaging tests.
Researchers, like Amanda Janitz, associate professor of epidemiology in the OU Hudson College of Public Health, worked to improve this offering. A pilot program funded by the American Cancer Society was conducted, providing enhanced American Indian Navigation services to help identify and address issues affecting access to cancer care.
“There were a lot of times frustrations and communication challenges here at the cancer center, also at the tribal health facilities,” Janitz, a member of the Choctaw Nation, said. "So we decided to continue moving this work forward."
The pilot served 128 patients from July 2023 to February 2025. It offered one-on-one contact with a nurse navigator to provide screenings assessing financial hardship, psychosocial needs, distress levels, rates of missed visits and adherence to cancer treatment. They also gave education on clinical trials and informed oncologists about patients’ concerns regarding research.
Researchers identified a decrease from 19% to 11% in missed appointments and an increase in depression screenings from 72% to 100%. Two-thirds of patients received financial support for transportation and lodging.
“It's a lot to manage when you have a very serious health condition,” Janitz said. “And then when you're having to travel several hours to come to Oklahoma City for your treatment, those barriers can occur.”
Janitz said they also scheduled regular virtual meetings between the navigator and tribal case managers for a few patients to see if they could address issues they face. The researchers found the communication helpful and feasible. Janitz said they hope to expand on those efforts in their upcoming project, called the Care Coordination and Communication Program in Oncology for Tribal Health Systems.
The work is funded by a $17.2 million National Institutes of Health grant OU received last year, which focuses on several activities related to cancer prevention, screening and care coordination.
Teams from the Stephenson Cancer Center and a referring facility will hold these virtual “huddles,” where clinicians can discuss the course of treatment and navigators and case managers can address psychosocial needs and any referral obstacles.
The huddles will also become part of a clinical trial slated to begin next year, Janitz said. Participants will be randomized to either receive huddles or standard navigation without them. But everyone will eventually receive enhanced services.
The goal is to have a long-term, positive effect on Indigenous Oklahomans.
“What I really like about these types of research projects is that we can see improvements for patients very quickly,” Janitz said. “… 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.”
Sarah Liese contributed to this report.
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