Forward Thinking; Daniel Petereit, MD, FASTRO
Feb 23, 2018 02:50PM ● Published by Alyssa McGinnis
By Alex Strauss
Daniel Petereit, MD, a radiation oncologist with Regional Health John T. Vucurevich Cancer Care Institute in Rapid City, is one of those people who gets an idea and runs with it.
Inspired by his father Frank Petereit, MD, a long-time radiologist in Sioux Falls who clamored his way out of a life of poverty, Petereit earned his medical degree at USD and did his residency in radiation oncology at the University of Wisconsin. He did additional training in gynecologic oncology and head and neck cancer at MD Anderson Cancer Center.
“I liked the multidisciplinary aspects of radiation oncology and appreciated that it can be curative as well as palliative,” says Dr. Petereit, who says he also enjoys building relationships with patients as they go through treatment. “In some specialties, you don’t get as much of that.”
Dr. Petereit spent 10 years training and teaching in the Department of Human Oncology at the University of Wisconsin-Madison where he led the radiation therapy portion of the gynecologic oncology service for 5 years. In 1999, he got an idea to return to his home state and bring what he calls “the culture of service and science in which I was immersed” to cancer care in the Black Hills region.
“I viewed it as an opportunity to bring services to this part of the country that weren’t being offered,” says Petereit. “At the time, 20 to 30 percent of Black Hills cancer patients were being referred out for more complicated treatments like brachytherapy.”
Petereit hit the ground running. Within his first two years, Regional Health’s first brachytherapy program was up and running. Shortly thereafter, Dr. Petereit returned to the University of Wisconsin with Regional Health administrators (Adil Ameer and Richard Haeder) to evaluate a new treatment called Tomotherapy – “an absolute game changer in the field of radiation oncology”, according to Petereit.
Under Dr. Petereit’s guidance, Regional Health became the fourth site in the world to implement the now familiar system which delivers image-guided IMRT (intensity modulated radiation therapy) with an integrated CT scanner in order to achieve a more conformal dose of radiation while sparing the adjacent normal tissues.
The forward momentum continued into 2001 with the National Cancer Institute’s announcement of new cancer disparity grants for community cancer centers gave Dr. Petereit another idea.
The grants were reserved for centers that were offering state-of-the-art cancer technologies and services and that had access to a population suffering from cancer disparities. Petereit recognized that Regional Health was a perfect fit. The following year, the John T. Vucurevich Cancer Care Institute secured its first-ever NCI grant and the Walking Forward program was born.
“We had the technology in place and we had access to this underserved population,” says Dr. Petereit. “All the stars really aligned when NCI began issuing these grants.”
The NCI-funded cancer disparity project called Walking Forward launched in 2002 with the aim of improving cancer treatment and outcomes among Northern Plains American Indians in the region. American Indians tend to present with much more advanced cancers and have the worst cancer-specific survival rates of any racial/ethnic minority group in the US.
Walking Forward offered a culturally tailored patient navigation program designed to bring more American Indians into clinical trials. Community Research Representatives offered educational programs encouraging screening and early detection and implemented surveys to identify barriers to access. Walking Forward also included trials focused on improving participation by reducing treatment length with advanced treatment technologies such as brachytherapy and IMRT.
“Mastectomy rates were also very high in the Black hills at that time,” says Dr. Petereit. “If a woman wanted to avoid mastectomy, she was looking at 6 weeks of radiation.”
But the new brachytherapy program could condense that time into just five days, making it much easier for patients who had to travel far from home. This was especially good news for American Indian women in the region, who live an average of 140 miles away from the cancer center.
“A big part of the program was just gaining the trust of the tribal community,” says Petereit.
Impact on Outcomes
More than 4,000 American Indians have been enrolled in various clinical trials as a result of Walking Forward—the highest in the nation for any program working with this population. Fifty papers on Walking Forward have been published in peer-reviewed journals and an analysis of the data suggests that American Indian cancer patients with screen-detectable cancers are now presenting with earlier stages of disease and experiencing higher cure rates.
Recently, a Walking Forward smoking cessation project included 256 American Indians in a randomized controlled trial using nicotine replacement, counseling, and text messaging to mitigate the high rates of tobacco use (40% to 50%) and tobacco-induced cancers. Twenty-five percent of participants were smoke free at six months.
In 2015, administration of the Walking Forward program was moved to Avera Health in Sioux Falls, where Dr. Petereit serves as Director of Disparity Research at the Avera Cancer Care Institute. He continues to live in the Black Hills and practice at Regional Health.
In an Executive Summary of the 15-year-old program, Petereit wrote, “Overall, the absolute persistence of the Walking Forward team, particularly when barriers to address these complex socio-economic issues appeared difficult or insurmountable, has led to the program’s longevity and continued success.
New opportunities continue to present themselves. Last month, the Bristol-Myers Squibb Foundation approved a 3-year 1.6 million dollar grant for the next iteration of Walking Forward— Increasing Lung Cancer Screening for High Risk Smokers in a Frontier Population project—a low-dose CT screening project which will begin in May.
In the future, the hope is that the lessons learned from Walking Forward can be applied to other indigenous populations with health disparities. Dr. Petereit is currently working with the International Cancer Expert Corps (ICEC), based in Washington, DC, to accomplish these goals.
Meanwhile, he is the incoming president of the American Brachytherapy Society and continues to be excited about advancing cancer care in the Black Hills. In recent years, stereotactic radiation has made it possible to treat small lung tumors with minimal side effects and high cure rates.
“This successful program is led by my partner Dr. Michael Swartz which will compliment the lung cancer screening project,” says Dr. Petereit. Regional also recently implemented MRI-guided brachytherapy for advanced cervical cancer, which may improve cervical cancer cure rates by 10 to 20 percent. Finally, in partnership with Avera, Regional Health patients can now undergo genomic profiling to further customize their cancer treatment when appropriate.
As he looks back at his progress and forward to his future, Dr. Petereit says he hopes he will not live out actor Graham Greene’s predictions when he said “Life is lived in the first 20 years.The remainder is just a reflection.”
“Hopefully, there has been some progress but I am hoping there is still more progress to come,” says Dr. Petereit.
Note: Dr. Petereit wishes to thank his Walking Forward staff, Regional Health and Avera Health, his partners Drs. Eric Eastmo and Michael Swartz, his friend and colleague Dr. Norm Coleman at the NCI, the American Indian community, and his wife Jean and their four kids for their support.