Group fighting Marshallese cancer travels to Arkansas

Islanders travel to Arkansas to develop survivorship plan

FAYETTEVILLE -- The numbers are high for an island nation with a population of about 55,000.

Cancer kills about 33 people on the Marshall Islands each year while doctors diagnose about 60 new cases annually.

By the Numbers

Below are statistics for Marshallese living on the island

• 6.4 percent adults ages 50-75 having fecal occult blood test screening for colorectal cancer

• 7.8 percent women received breast cancer screening through examination or mammogram

• 36.4 percent of women screen for cervical cancer

• 60 percent of people aged 15-64 at high risk of developing diabetes, cancer and stroke

• 60 percent are overweight or obese

• 20 percent are tobacco users

• 20 percent have high blood pressure

Source: Republic of the Marshall Islands Comprehensive Cancer Control Program

Cervical cancer is prevalent on the islands, with about 10 new cases diagnosed annually. The Marshall Islands has the world's highest rate of cervical cancer at 79.7 cases per 100,000 women; the rate among American women is 18.6 per 100,000.

Prevention and screenings are difficult because of a lack of education and resources. Patients must travel to Hawaii or the Philippines for treatment because there isn't an oncologist on the Marshall Islands. And for those who survive, there is no plan to help them live a better life.

The newly opened Center for Pacific Islander Health in Fayetteville hopes to help. A small contingent of doctors and cancer survivors from the Marshall Islands visited Arkansas this week to create a cancer survivorship plan that will be part of the Marshall Island's National Comprehensive Cancer Control Program.

The National Cancer Institute defines cancer survivorship as a focus on the health and life of a person with cancer post treatment until the end of life and covers the physical, psychosocial and economic issues of cancer, beyond the diagnosis and treatment phases.

Nia Aitaoto, the Pacific Islander center's co-director, said Thursday the trip opens a needed line of communication. She is also an evaluator for the cancer control program. "This is a dialogue, and dialogue never ends."

Aitaoto coordinated visits between the Marshall Islanders and some of the state's leading cancer service providers, including the Winthrop P. Rockefeller Cancer Institute in Little Rock and Hope Cancer Resources in Springdale. The group held a public discussion Thursday at the University of Arkansas for Medical Sciences Northwest.

Dr. Thomas Schulz said the week's meetings was the first step in building a long-term collaborative relationship between the University of Arkansas for Medical Sciences and Marshall Island health care providers.

"I also hope that we can help them obtain sorely needed funds and equipment to not only optimally care for these survivors, but to improve access to care for screening with the goal of prevention in mind," he wrote in an email.

Brian Holt, president and CEO of Hope Cancer Resources, said the visitors learned about Hope's services, and he learned about their needs.

"Having Nia here will help open some doors," he said. "We will help however we can."

The visit could also add resources for the local Marshallese population, which the medical school estimates is between 10,000 and 14,000. Holt said he is looking into starting a support group for local cancer survivors.

Carmen Chong Gum, consulate general in Arkansas for the Republic of the Marshall Islands, said nine of the 24 local Marshallese residents who died last year died of cancer.

"Help the consulate to educate more people," she said during Thursday's discussion. "We need to talk more."

Making a plan

Dr. Richard M. Trinidad, a consultant to the Marshall Islands' Ministry of Health and Comprehensive Cancer Control Programs, said the ministry recently completed an assessments report on cancer survivorship. He said a plan is needed for the increasing number of people living with and surviving cancer on the islands.

The cancer control program is working on improving cancer resources from screening to after-care. Trinidad said as more people are screened, more cancers will be caught early and will create even more survivors.

"They have different needs and challenges," he said. "It's the humane thing to do."

High cancer rates on the islands is not a new phenomenon and this is not the first study to look at improving cancer screening, prevention and treatment. It is this first time survivorship is part of the comprehensive plan.

A main reason for the high rates is radioactive fallout from the U.S. testing of nuclear bombs in the Marshall Islands between 1946 and 1962, according to a 2004 paper on cancer in Marshall Islands funded by the National Cancer Institute. The report states radioactive material absorbed from contaminated food and water caused increases in leukemia, breast cancer and thyroid cancer.

The U.S. took over administrative control of the Marshall Islands after World War II, signed a Compact of Free Association in 1983, and the island nation gained independence in 1986. The compact allows Marshallese to work and study in the United States without a visa, but they aren't citizens and don't qualify for many government programs offered here such as Medicaid.

Aitaoto chocked back tears as she told the group Thursday health disparities on the Pacific island nations is a social injustice.

"We can not fight this by ourselves," she said.

The 2004 study called for additional training, equipment and programs on the islands to lower cancer rates. cancer rates have changed little since that report, but Aitaoto said this time is different.

"They didn't have the resources to fully implement it," she said of the 2004 plan. "If you can't get a mammography machine and the training for it, it throws off everything you want to do for breast cancer."

Several years ago a women's group donated a mammogram machine to the islands, but it wasn't used because no one knew how to operate or repair the machine, said Dr. Helentina Garstang, a physician at the Republic of the Marshall Islands Ministry of Health and director of the Marshall Islands' Cancer Council of the Pacific Islands committee.

Garstang said the doctors received a new machine last year and a female technician learned how to operate it. Breast cancer is the third most common cancer on the islands, and only 7.8 percent of women received a mammogram in 2013.

Aitaoto said the current effort is already different because it's creating a realistic plan with resources in place to implement it. The group's trip to Arkansas shows they are looking for resources outside the island and region.

"Now we have the Center for Pacific Islander Health, we have UAMS, we have collaborators and researchers and doctors and evaluators and people who want to work together and who understand that we're all in this together," she said.

The survivorship plan outlines recommendations including increased training and education, more staffing for survivorship care; developing wrap-around support services such as nutrition and employment support and establishing clinical care guidelines.

Island challenges

Part of the cancer prevention and treatment problem on the Marshall Islands is the sure scope of the area doctors must cover.

The nation includes two parallel island chains made of 29 atolls and five individual islands totaling about 1,225 islands and 870 reef systems spread over 750,000 square miles midway between Hawaii and Australia in the Pacific Ocean. The chains are about 125 miles apart and extend about 800 miles northwest to southeast.

The size of the Marshall Islands is about 14 times the size of Arkansas and traveling across the nation from top to bottom would be like going from Fayetteville to Denver.

About 30 percent of the population lives on the outer islands.

Garstang said the Marshall Islands has 20 doctors and health assistants, comparable to physician assistants in the U.S., see patients on many atolls.

She said all doctors see all types of patients and they try to cover two or three atolls every couple of weeks.

Language and cultural barriers are also a problem. Only 20 percent of the island's doctors speak Marshallese.

The Marshall Island health system also has monetary limits for coverage. Most patients have to stop treatment once the money is gone, Garstang said. The $100,000 annual limit does not always stretch far enough for cancer patients.

Maureen Milne runs into this problem. The 26-year-old Marshallese woman was diagnosed with chronic leukemia four years ago during a screening before she entered college.

She said her money ran out, and she's no longer able to get the medication she needs. Garstang is her doctor on the island and said all they can do for her is a blood test. She can't afford to travel to either Hawaii or the Philippines to see an oncologist.

She was able to discuss her health issues with Schulz while in Arkansas and is taking back some tips to help improve her health.

Garstang said Milne is an example of why it would be good to have an oncologist make annual visits to the island.

Schulz may be the oncologist who travels to the islands.

"Cancer survivorship programs are more important than ever in the Marshall Islands, given the distance from their treatment locations and the fact that they have no access to followup from these institutions and no oncologists are on the island," he said.

"I am fortunate to have been invited to share ideas of how I think I can help, which include devising surveillance plans specific to what is available on the islands and for me to visit the islands regularly to see survivors in the clinic as an oncologist."

NW News on 08/22/2015

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