Asian American Cancer Initiative Focuses on Filipino Immigrants
(Spring 2004)

In 2003 the Cancer Research Center received a $30,000 award from the National Cancer Institute (NCI) to participate in the Asian American Network for Cancer Awareness, Research and Training (AANCART). The award funded the Cancer Center to conduct fact finding and a needs assessment of the status of cancer in Hawai‘i’s immigrant Asian populations. The results will now be used to guide strategic planning and develop appropriate interventions to increase cancer awareness, encourage clinical trials participation, and increase the number of Asian American and other professional involved in cancer research through education and training. AANCART is the first federal program among NCI’s 18 Special Populations Network programs, and the largest aimed at curbing cancer in Asian Americans. There are currently eight participating AANCART sites across the nation.

The Hawai‘i AANCART project’s needs assessment revealed significant disparity among Hawai‘i’s Asian groups. According to the Hawai‘i Tumor Registry, of all types of cancers diagnosed between 1995-2000 among people of Asian ancestry, the three most frequently occurring cancers were prostate, breast and lung. Filipinos represented the highest percentage of cancer cases at 58 percent, followed by the Japanese at 17.5 percent and the Chinese at 13.7 percent.

According to the 2000 U.S. Census, Asians represent 3.6 percent of the United States population, with Hawai‘i leading the nation with 41.6 percent of its 1.2 million people reporting an Asian heritage. As a state, Hawai‘i has the fourth highest percentage of foreign-born residents in the U.S. Filipinos comprise the largest immigrant group in Hawai‘i at 61%, compared to all the other immigrant groups combined. Preliminary findings from the Hawai‘i Tumor Registry show that foreign-born Asians, when compared to U.S.-born Asians and Caucasians, have a lower percentage of cancer diagnosed at an early stage, a higher percentage of cancer diagnosed at a late stage, and lower rates of cancer survival. Among the possible reasons cited for this disparity is poor physician-patient communication, resulting in inadequate follow-up with physician orders. The language and socio-cultural barriers are other reasons for patients’ discomfort in verbalizing health-related complaints and for the inconsistencies in following physicians’ orders.

The AANCART program at the Cancer Center will seek initial partnerships with Filipino leaders to develop a strategic planning tool that will address cancer disparities in their communities. An infrastructure and capacity-building award of $100,000 has been received from the NCI’s Special Populations Network to carry out the planning phase of the AANCART project in preparation for minority cancer research and training grants in the near future.

Charlene Cuaresma, Special Populations Liaison of the National Cancer Institute’s Cancer Information Service of Hawai‘i, also serves as Hawai‘i AANCART’s community director and steering committee member. “AANCART partnerships for cancer awareness, research, and training engage intergenerational Filipino leadership to gain parity as a major cancer stakeholder to improve current measures to reduce the uneven burden of cancer,” says Cuaresma.

Dr. Moon Chen, of the University of California at Davis, is the lead investigator for the AANCART’s national program. Other institutions participating in the national AANACART project include Dana-Farber Caner Institute in Boston, Herbert Irving Comprehensive Cancer Center in New York City, Solove Cancer Research Center in Columbus, Ohio, Fred Hutchinson Cancer Research Center in Seattle, UCSF Comprehensive Cancer Center in San Francisco, and Johnsson Comprehensive Cancer Center at UCLA.

Dr. Reginald Ho, medical oncologist at Straub Clinic & Hospital, serves as the national AANCART clinical director, as well as Hawai‘i AANCART’s principal investigator. The Hawai‘i AANCART steering committee is composed of partners from the following agencies: Straub Clinic & Hospital – Dr. Reuben Guerrero, medical oncologist and AANCART clinical director; NCI’s Cancer Information Service – Hali Robinett, project director; Cancer Research Center of Hawai‘i, University of Hawai‘i – Dr. Abraham Nomura, professor and researcher and AANCART research director; American Cancer Society Hawaii Pacific, Inc. – Stephen Jiang, health initiatives director; and Hawai‘i State Department of Health Prevention and Tobacco Coalition – Lila Johnson, coalition coordinator.

Studies have shown that it takes about three generations for immigrants to become westernized and acculturated to its adopted country. Meanwhile, among first generation Filipinos, cancer rates may be increasing significantly. To facilitate its work with Hawaii’s Filipino population, the AANCART project is forging partnerships with the Kauai Filipino Community Council, Oahu Filipino Community Council, United Filipino Community Council of Hawaii, which is the umbrella organization for more than 200 Filipino organizations, and other institutions serving Filipinos.

In the first quarter of 2004 leadership forums were held on Oahu and Kauai. They were designed to raise awareness, provide training, and empower Filipino leaders to be informed. They are the major stakeholders who can play a vital role in reducing the burden of cancer in their communities. Through these forums, attendees have the opportunity to learn what cancer is and how the disease affects Filipinos in Hawai‘i, share their insights to barriers to cancer prevention, screening, treatment, and survivorship faced by Filipinos; recommend actions to reduce the cancer burden; and contribute input to a strategic planning tool that will be made available to Filipino organizations and agencies to facilitate partnerships with other cancer stakeholders to promote good health for present and future generations.

Successes and lessons learned will also facilitate capacity building strategies for cancer and tobacco control measures for other Asian groups. This aids in positioning Hawai‘i AANCART to become a full project site in the next generation of the Special Populations Network five-year funding cycle.